Clinical Care Manager-RN; MA)

Well Sense Health Plan is a nonprofit health insurance company serving more than 680,000 members across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans. Founded more than 25 years ago as Boston Medical Center Health Net Plan, we provide plans and services that work for our members, no matter their circumstances.

It’s an exciting time to join the Well Sense Health Plan, a growing regional health insurance company with a 25-year history of providing health insurance that works for our members, no matter their circumstances.

The Clinical Care Manager provides holistic clinical care management services for members across the continuum of care through comprehensive assessment, care planning, education, care coordination, advocacy, and ongoing monitoring. The Clinical Care Manager works collaboratively with members, families, providers, community organizations, and multidisciplinary care teams to improve health outcomes, promote self-management, address barriers to care, and ensure appropriate utilization of healthcare services.

The Clinical Care Manager supports diverse member populations, including individuals with chronic and complex medical conditions, behavioral health comorbidities, special health care needs, maternal-child health needs, newborns with complex medical conditions, high-risk and priority populations, individuals experiencing homelessness, and members requiring intensive care coordination across multiple systems of care.

Utilizing telephonic outreach, virtual engagement, data analysis, and face-to-face visits, the Clinical Care Manager conducts assessments, develops individualized care plans, coordinates services, and promotes member engagement through evidence-based practices and motivational interviewing techniques. The role emphasizes whole-person care by integrating medical, behavioral health, psychosocial, socioeconomic, and community-based supports.

Our Investment in You:

Supports programs and clinical best practices with the objective of improving health outcomes, preventing hospital readmissions, improving member safety and reducing medical errors, and promoting health and wellness activities, where appropriate.

Completes comprehensive assessments, medication reconciliations, targeted clinical assessments, and condition-specific evaluations to identify members' medical, behavioral, psychosocial, functional, and social determinants of health needs.

Evaluate members for complex care management, disease management, chronic condition management, maternal-child health programs, and other specialized care management services.

Collaboratively develop, implement, monitor, and update individualized care plans based on member goals, clinical needs, and available resources.

Establish short-term and long-term goals that support improved clinical outcomes, self-management, and quality of life.

Continuously evaluate the effectiveness of interventions and revise care plans as needed.

Utilize motivational interviewing and evidence-based engagement techniques to promote member participation in care management and support behavior change.

Educate members and caregivers regarding disease processes, preventive care, treatment plans, medication adherence, and self-management strategies.

Provide health education using culturally appropriate and health literacy-sensitive materials.

Support members in understanding and navigating healthcare benefits, services, and available community resources.

Promote member adherence to prescribed treatment plans and preventive health recommendations.

Coordinate services across the healthcare continuum, including primary care, specialty care, behavioral health, pharmacy, community services, and state agencies.

Facilitate transitions of care through pre-admission assessments, discharge planning, medication reconciliation, appointment scheduling, and follow-up activities.

Identify and address barriers to care, including transportation, housing, food insecurity, financial challenges, and other social determinants of health.

Coordinate referrals to internal and external programs and resources, including but not limited to behavioral health, social care management, community health workers, home health services, durable medical equipment, and community-based organizations.

Collaborate with providers, hospitals,…