RN Care Manager
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Job Description
Mobile RN care manager coordinating complex Medicare and Medicaid member care across Massachusetts. Conducting assessments, care planning, provider collaboration, and community visits.
Responsibilities:
- 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
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