Clinical Care Manager Nurse

The Opportunity
Mass General Brigham Health Plan seeks a Registered Nurse (RN) Clinical Care Manager to work as part of an interdisciplinary care team providing care management for health plan enrollees with complex medical, behavioral, and social needs, including Severe and Persistent Mental Illness (SPMI).
As a clinical expert on the interdisciplinary team, the Clinical Care Manager conducts assessments, develops enrollee centered care plans, coordinates care, provides health education, and collaborates with providers to ensure comprehensive support.
This position requires an active RN license and a hybrid working model, including practice-based, remote work and enrollee in-person home and community visits as needed.
The population will primarily include enrollees residing in Essex, Middlesex, Suffolk, Norfolk, Plymouth, Bristol, Dukes, and Nantucket counties. The Clinical Manager's responsibilities and caseload may be adjusted based on enrollee enrollment trends.
What You'll Do:
-Collaborate with the interdisciplinary care team-including LTSC, GSSC, primary care providers, and specialists-to support program enhancements, process improvements, and comprehensive care coordination.
-Participate in interdisciplinary care team meetings, ensuring medication reconciliation, timely follow-ups after hospitalization, quality gap closures, and consistent communication with providers and enrollees.
-Develop, update, and implement individualized, enrollee-centered care plans in collaboration with enrollees and the care team, incorporating self-care, shared decision-making, and addressing behavioral health needs.
-Conduct outreach, assessments, and home visits using telephonic, electronic, or in-person methods to evaluate clinical status, identify needs, and provide ongoing community-based care management or appropriate referrals.
-Monitor enrollees' clinical status for early signs of deterioration, proactively intervene to prevent unnecessary hospitalizations, and act as the clinical escalation point for urgent issues through triage, telephonic support, and care coordination.
-Provide health education, coaching, and routine engagement to assigned enrollees, proactively addressing questions, concerns, and facilitating access to providers and supportive services.
-Utilize electronic medical record systems to accurately document, monitor, and evaluate enrollee interventions and care plans, ensuring compliance with DSNP regulations and internal policies.
-Serve as a clinical resource and lead interdisciplinary care team member for assigned enrollees, supporting compliance initiatives, quality assurance, and collaborating with care management leadership on challenging cases.
-Perform additional duties as assigned by supervisors to support care management goals and promote enrollee well-being.

Qualifications

• Associate's Degree Nursing required or Bachelor's Degree Nursing preferred
• Massachusetts Registered Nurse required
• Basic Life Support [BLS Certification] preferred
• At least 2-3 years of experience in health plan or community case management is highly preferred
• Experience with Dual Eligible Populations (Medicare and Medicaid) highly preferred
• Certified Case Management Certificationpreferred

Skills for Success

• Exceptional communication abilities with active listening skills
• Using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions or approaches to problems.
• Ability to establish strong rapport and relationships with patients and staff.
• Proficient in Microsoft Office and industry related software programs.
• Identifying complex problems and reviewing related information to develop and evaluate options and implement solutions.
• Ability to maintain client and staff confidentiality.
• Understanding of diagnostic criteria for dual conditions and the ability to conceptualize modalities and placement criteria within the continuum of care.
• Knowledge of Healthcare and Managed Care preferred.

Working Model Required

• M-F Eastern Business Hours required 830a-5pm ET
• This is a full-time, benefits eligible role
• Onsite Practice-based, remote work and enrollee in-person home and community visits
• Weekly multiple, variable days in the field needed
• Reliable transportation and valid driver's license required
• Must be local, ideally in Eastern, MA. Community capable with autonomy to build own schedule to accommodate members' needs.
• The Clinical Care Manager must be flexible for training, field work and business needs, this can very per week in person, as well as telephonic or virtual assessments are possible.
• Field work may be increased as the program launches
• Remote working days require stable, quiet, secure, compliant working station

Our goal will be to geographically align Clinical Care Managers (3), this depends on residence, and can vary based on business needs, member enrollment and team staffing.

The population will primarily include enrollees residing in Essex, Middlesex, Suffolk, and Norfolk counties. The Clinical Care Manager's responsibilities and caseload may be adjusted based on enrollee enrollment trends.

Mass General Brigham Health Plan Holding Company, Inc. is an Equal Opportunity Employer. By embracing diverse skills, perspectives and ideas, we choose to lead. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment.

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