RN Care Manager

🔥 2 minutes ago

🍂 Massachusetts – Remote

🍂 Massachusetts – Remote

💵 $80k - $120k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

🦅 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

• Engage with enrollees in homes and community settings to establish complex care management relationships • Monitor, follow up, and provide clinical care management for dually eligible enrollees with complex medical, behavioral, and social needs • Integrate health services and community resources to coordinate care and improve outcomes • Liaise between healthcare providers, community resources, and enrollees • Perform Comprehensive, MDS-HC or successor Functional, Crisis, and Risk Assessments • Develop and implement care plans with enrollees and provide updates as status changes • Lead interdisciplinary care teams and collaborate with internal and external peers • Oversee utilization of long-term services and supports • Assist members with housing, transportation, food assistance, and social services • Educate members about Medicare and Medicaid benefits and available services • Educate members and families about chronic conditions, medication adherence, preventive care, healthy lifestyles, and self-management • Support preventive health strategies and gap closure • Follow up after hospitalizations and significant health events to ensure continuity and prevent readmissions • Coordinate with 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 • Report abuse, neglect, or exploitation as a mandated reporter • Adhere to NCQA and care management standards • Perform other job-related duties as requested

🎯 Requirements

• Associates of Science (A.S) degree in nursing from an accredited nursing program required, or Master's degree in social work or mental health counseling and independent license required • Three (3) years of experience as a Registered Nurse/BH Clinician, or one (1) year as a Registered Nurse/BH Clinician with two (2) years of experience working with people with complex medical, behavioral and social needs as an LPN, CHW, or MA • Current unrestricted clinical license in the Commonwealth of Massachusetts as an RN, LCSW, LICSW, or LMHC required • Intermediate proficiency with Microsoft Office, including Outlook, Word, and Excel • Understanding of Medicare and Medicaid programs and community resources for dual-eligible beneficiaries • Strong written and verbal communication, interpersonal, customer relations, and customer service skills • Ability to manage multiple cases and priorities with attention to detail • Ability to work independently and as part of an interdisciplinary team • Awareness and sensitivity to diverse backgrounds and needs • Decision-making and problem-solving skills • Must have valid driver's license, vehicle, and verifiable insurance • Successful driver's license record check required • Annual Influenza vaccination required during Influenza season • Must reside in the assigned territory and within commutable distance to the Commonwealth of Massachusetts • Ability to travel greater than 50% of the time

🏖️ Benefits

• Bonus tied to company and individual performance may be available • Comprehensive total rewards package • Reasonable accommodations for qualified individuals • Flexible hours, including possible evenings and/or weekends • Mobile work arrangement with regular travel to homes, offices, and public settings