Clinical Care Manager, RN

CareSource

. Provide monitoring, follow-up, and clinical care management to dually eligible enrollees with complex medical, behavioral, and social care needs .

Posted 10/28/2026full-timeCambridge • Massachusetts • United StatesMid-LevelSenior💰 $90,000 - $120,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in clinical care management for dually eligible enrollees, including comprehensive assessments, care plan development, and interdisciplinary collaboration. Proficient in navigating Medicare and Medicaid programs while advocating for member needs and promoting preventive health strategies.

Highest-signal resume keywords

Registered Nurse LicenseClinical Care ManagementMedicare and Medicaid KnowledgeInterdisciplinary Team LeadershipCrisis Assessment

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Comprehensive AssessmentsCare Plan DevelopmentCrisis ManagementRisk AssessmentUtilization ManagementMedication Adherence EducationPreventive Care StrategiesCommunity Resource CoordinationMember Satisfaction EvaluationCase Management

Soft Skills

Interpersonal SkillsCommunication SkillsCustomer Service SkillsDecision-Making SkillsProblem-Solving Skills

Tools & Technologies

Microsoft OfficeOutlookWordExcel

Certifications & Qualifications

Associate of Science Degree in NursingMaster's Degree in Social Work or Mental Health CounselingCurrent Clinical License in Massachusetts

Industry Keywords

Dually Eligible EnrolleesLong-Term Services and SupportsSocial ServicesHealthcare ProvidersCommunity OrganizationsNCQA StandardsPreventive Health StrategiesHousing AssistanceTransportation AssistanceFood Assistance

About the role

Key responsibilities & impact

Provide monitoring, follow-up, and clinical care management to dually eligible enrollees with complex medical, behavioral, and social care needs
Engage enrollees in their homes and community settings to establish care management relationships
Liaise between healthcare providers, community resources, and enrollees
Perform comprehensive, functional, crisis, and risk assessments
Develop and update enrollee care plans
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, Medicaid, chronic conditions, medication adherence, preventive care, and benefits
Promote healthy lifestyle choices and self-management strategies
Support preventive health strategies and gap closure
Follow up after hospitalizations and significant health events to prevent readmissions
Coordinate care 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

What you’ll need

Associate of Science (A.S.) degree in nursing from an accredited nursing program required, or Master's degree in social work or mental health counseling with independent license required
Three years of experience as a Registered Nurse/BH Clinician, or one year as a Registered Nurse/BH Clinician with two 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 interpersonal, communication, customer relations, and customer service skills
Ability to manage multiple cases and priorities while maintaining attention to detail
Ability to function independently and as part of an interdisciplinary team
Awareness of and sensitivity to diverse backgrounds and needs
Decision-making and problem-solving skills
Valid driver's license, vehicle, and verifiable insurance
Successful clearance of a driver's license record check
Annual influenza vaccination required during influenza season
Must reside in the assigned territory and within commutable distance to the Commonwealth of Massachusetts
Willingness and ability to travel greater than 50% of the time
Flexible availability, including possible evenings and weekends

Benefits

Comp & perks

Bonus tied to company and individual performance may be available
Comprehensive total rewards package
Flexible hours, including possible evenings and/or weekends
Reasonable accommodations for qualified individuals
Annual influenza vaccination coverage/requirement for designated positions