Hybrid Registered Nurse (RN) Case Manager SIGN ON BONUS

Job Summary

The Integrated Care Clinical Manager - Massachusetts is a community based
registered nurse responsible for providing monitoring, follow-up and clinical
care management to dually-eligible enrollees with complex medical, behavioral
and social care needs. This position focuses on integrating health services and
community resources to coordinate enrollee care for improve health outcomes and
enhanced quality of life.

Essential Functions

* Engage with the enrollee in their homes and other community settings to
establish an effective, complex care management relationship, while
considering the cultural and linguistic needs of each member.
* Function as a liaison between healthcare providers, community resources, and
enrollees to ensure seamless communication and care transitions.
* Perform required assessments on a timely basis, including but not limited to
Comprehensive Assessment, MDS-HC (or successor) Functional Assessments, and
Crisis and Risk Assessments
* Engage enrollees in care plan development and implementation, providing
routine updates as the enrollee’s status changes
* Lead the interdisciplinary care team (ICT) and collaborate with peers both
internal and external to the organization, to create holistic care plans that
address medical and non-medical needs.
* Oversee enrollee utilization of long-term services and supports, ensuring
appropriate systems are in place for enrollees to remain in the location of
their choice
* Assist members in accessing community resources, including housing,
transportation, food assistance, and social services.
* Educate members about their benefits and available services under both
Medicare and Medicaid.
* Provide education to members and their families about managing chronic
conditions, medication adherence, and preventive care.
* Promote healthy lifestyle choices and self-management strategies.
* Assist enrollees in preventative health strategies, including gap closure
* Follow up with members after hospitalizations or significant health events to
ensure continuity of care and prevent readmissions.
* Work closely with primary care physicians, specialists, and other healthcare
providers to coordinate care and share relevant information.
* Coordinate with community-based organizations, other stakeholders/entities,
state agencies, and other service providers to ensure coordination and avoid
duplication of services.
* Advocate for the needs and preferences of enrollees within the healthcare
system.
* Evaluate member satisfaction through open communication and monitoring of
concerns or issues.
* Regular travel to conduct member, provider and community-based visits as
required
* Report abuse, neglect, or exploitation of older adults and adults with
disabilities as a mandated reporter as required by State law.
* Adherence to NCQA and Care Management standards
* Perform any other job related duties as requested.

Education and Experience

* Associates of Science (A. S) degree in nursing from an accredited nursing
program required
* A Registered Nurse with the ability to independently serve people with
complex medical, behavioral, and social needs. required
* 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

Competencies, Knowledge and Skills

* Intermediate proficiency level with Microsoft Office, including Outlook, Word
and Excel.
* Understanding of Medicare and Medicaid programs, as well community resources
and services available to dual-eligible beneficiaries.
* Strong interpersonal and communication skills to effectively engage with
members, families, and healthcare providers
* Ability to manage multiple cases and priorities while maintaining attention
to detail.
* Adhere to code of ethics that aligns with professional practice.
* Awareness of and sensitivity to the diverse backgrounds and needs of the
populations served
* Decision making and problem-solving skills.
* Ability to function independently and effectively as part of an
interdisciplinary team
* Strong and effective communication skills, both written and verbal
* Strong interpersonal and customer relations skills
* Strong customer service skills

Licensure and Certification

* Current unrestricted clinical license in the Commonwealth of Massachusetts as
a Registered Nurse (RN) required
* Case Management Certification is highly preferred
* Must have valid driver's license, vehicle and verifiable insurance.
Employment in this position is conditional pending successful clearance of a
driver’s license record check. If the driver’s license record results are
unacceptable, the offer will be withdrawn or, if employee has started
employment in position, employment in this position will be terminated
* To help protect our employees, members, and the communities we serve from
acquiring communicable diseases, Influenza vaccination is a requirement of
this position. CareSource requires annual proof of Influenza vaccination for
designated positions during Influenza season (October 1 – March 31) as a
condition of continued employment. Employees hired during Influenza season
will have thirty (30) days from their hire date to complete the required
vaccination and have record of immunization verified.
* CareSource adheres to all federal, state, and local regulations. CareSource
provides reasonable accommodations to qualified individuals with disabilities
or medical conditions, sincerely held religious beliefs, or as required by
state law to enable the employee to perform the essential functions of the
position. Request for accommodations will be completed through an interactive
review process.

Working Conditions

* This is a mobile position, meaning that regular travel to different work
locations, including homes, offices or other public settings, is essential.
Will be exposed to weather conditions typical of the location and may be
required to stand and/or sit for long periods of time. Must reside in the
same territory they are assigned to work in; exceptions may be considered,
due to business need May be required to travel greater than 50% of time to
perform work duties. Required to use general office equipment, such as a
telephone, photocopier, fax machine, and computer Flexible hours, including
possible evenings and/or weekends as needed to serve the needs of our members
* Must live within commutable distance to the Commonwealth of Massachusetts
* Over 50% (Mobile) Routine travel required

Compensation Range

$80,000 - $120,000

CareSource takes into consideration a combination of a candidate’s education,
training, and experience as well as the position’s scope and complexity, the
discretion and latitude required for the role, and other external and internal
data when establishing a salary level. In addition to base compensation, you may
qualify for a bonus tied to company and individual performance. We are highly
invested in every employee’s total well-being and offer a substantial and
comprehensive total rewards package.

Compensation Type (hourly/salary)

Salary

Organization Level Competencies

* Fostering a Collaborative Workplace Culture

* Cultivate Partnerships

* Develop Self and Others

* Drive Execution

* Influence Others

* Pursue Personal Excellence

* Understand the Business

THIS JOB DESCRIPTION IS NOT ALL INCLUSIVE. CARESOURCE RESERVES THE RIGHT TO
AMEND THIS JOB DESCRIPTION AT ANY TIME. CARESOURCE IS AN EQUAL OPPORTUNITY
EMPLOYER. WE ARE DEDICATED TO FOSTERING AN ENVIRONMENT OF BELONGING THAT

Welcomes and Supports Individuals of All Backgrounds.

Brand=Commonwealth Care Alliance