CareSource·Boston, Massachusetts
The Clinical Care Manager provides community-based monitoring, follow-up, and clinical care management for dually-eligible enrollees with complex needs, focusing on integrating health services and community resources to improve outcomes. Key duties include engaging members in their homes, leading interdisciplinary care teams, performing required assessments, and coordinating care transitions across various providers and community organizations.
The Integrated Care Clinical Manager - Massachusetts at CareSource/Commonwealth Care Alliance (CCA) 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.
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.
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.
$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.
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
Candidates must possess an Associate of Science degree in nursing or a Master's degree in social work/mental health counseling with an independent license, along with significant experience as a Registered Nurse or related clinician working with complex medical and behavioral needs. A current unrestricted clinical license in Massachusetts (RN, LCSW, LISCW, or LMHC) and a valid driver's license are mandatory.
Market context
In Massachusetts, nursing roles often draw steady demand, especially in specialty settings like oncology where prior RN experience can matter. These positions are competitive because employers commonly look for an active RN license, an ADN at minimum, and prefer candidates with oncology background and a BSN. Review the AI-summarized requirements and benefits on this platform to save time, then tailor your application to highlight oncology experience, licensure, and any relevant advancement or recognition achievements.
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