Registered Nurse (RN) Clinical Care Manager

🔥 0 minutes ago

🍂 Massachusetts – Remote

🍂 Massachusetts – Remote

💵 $90k - $120k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 0%

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CareSource

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 30+ years

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

CareSource is a health services company focused on providing affordable health insurance and healthcare solutions. It offers a wide range of plans including Medicaid, Marketplace, and Medicare Advantage, targeting low-income adults, families, children, pregnant women, elderly adults, and people with disabilities. Additionally, CareSource provides members with resources for COVID-19 support, dental, vision, and hearing benefits, as well as pharmacy services. The company emphasizes easy access to healthcare management through online platforms and a mobile app.

📋 Description

• Provide monitoring, follow-up, and clinical care management to dually eligible enrollees with complex medical, behavioral, and social care needs • Engage enrollees in their homes and community settings to establish complex care management relationships • Liaise between healthcare providers, community resources, and enrollees to support communication and care transitions • Perform comprehensive, functional, crisis, and risk assessments • Develop and implement care plans with enrollees and provide updates as conditions change • Lead interdisciplinary care teams and create holistic care plans addressing medical and non-medical needs • Oversee utilization of long-term services and supports • Assist members with housing, transportation, food assistance, and social services • Educate members about Medicare, Medicaid, benefits, chronic-condition management, medication adherence, and preventive care • Promote healthy lifestyle choices and self-management strategies • Support preventive health strategies and gap closure • Follow up after hospitalizations and significant health events to promote continuity and prevent readmissions • Coordinate care with primary care physicians, specialists, healthcare providers, community organizations, state agencies, and other stakeholders • Advocate for enrollee needs and preferences • Evaluate member satisfaction and monitor concerns • Conduct regular member, provider, and community-based visits, with travel potentially exceeding 50% of working time • Report abuse, neglect, or exploitation as a mandated reporter under state law • Adhere to NCQA and Care Management standards • Perform other related duties as requested

🎯 Requirements

• Associates of Science (A.S.) degree in nursing from an accredited nursing program required • Registered Nurse with ability to independently serve people with complex medical, behavioral, and social needs • Current unrestricted clinical license in the Commonwealth of Massachusetts as a Registered Nurse (RN) required • Valid driver's license, vehicle, and verifiable insurance • Successful clearance of a driver's license record check • Annual proof of Influenza vaccination during Influenza season (October 1–March 31) • Intermediate proficiency with Microsoft Office, including Outlook, Word, and Excel • Understanding of Medicare and Medicaid programs and community resources available to dual-eligible beneficiaries • Strong interpersonal and communication skills • Ability to manage multiple cases and priorities while maintaining attention to detail • Adherence to a professional code of ethics • Ability to function independently and as part of an interdisciplinary team • Strong customer relations and customer service skills • Must reside in the assigned territory • Must live within commutable distance to the Commonwealth of Massachusetts • Prior experience in care coordination, case management, or working with dual-eligible populations preferred • Medicaid and/or Medicare managed care experience preferred • Clinical Field/Community Based Training a plus • Case Management Certification highly preferred

🏖️ Benefits

• Bonus tied to company and individual performance may be available • Comprehensive total rewards package • Reasonable accommodations for disabilities, medical conditions, and sincerely held religious beliefs • Annual Influenza vaccination provided as a condition of continued employment • Flexible hours, including possible evenings and/or weekends • Mobile work arrangement with travel to homes, offices, and public settings