Nursing Jobs in Walpole, MA
$90,000 - $120,000 / year
Job Summary: The Clinical Care 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 Performs any other job related duties as requested. Education and Experience: 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, MA required Prior experience in care coordination, case management, or working with dual-eligible populations preferred Medicaid and/or Medicare managed care experience preferred 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), Licensed Clinical Social Worker (LCSW), Licensed Independent Clinical Social Worker (LISCW), or a Licensed Mental Health Counselor (LMHC) 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: $90,000 - $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. 
$122,803.20 - $173,867.20 / year
Site: The General Hospital Corporation Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham. Currently recruiting for Cutaneous oncology & GI oncology on MGH Main campus. This is a full time, 40hr position, four 10-hr M-F, no weekends or holidays Join a supportive and growing medical oncology Advanced Practice Team in a role supporting the Mass General Cancer Center at our Boston-based academic medical centers and/or network sites. Mass General Cancer Center specializes in the care of patients with a variety of hematologic malignancies and solid tumor oncologic diagnoses. Our team has a demonstrated history of providing exquisite, evidence-based patient care. This is a fantastic opportunity for an Advanced Practice Provider (NP or PA) to work in an invigorating and collaborative care environment. The medical oncology APP will provide direct and indirect care to ambulatory patients. With an interdisciplinary team approach, this provider will promote a collaborative relationship between all providers, professional nurses and administrative staff, to ensure continuity of patient care and efficient use of resources. Within this role, the advanced practice provider will partner with an attending oncologist(s) in the care of a consistent panel of patients though cross-coverage is expected. We have a strong emphasis on a consistent and sustainable work-life balance and a culture committed to minimizing the risk of burn out. Our practice environments reflect the values of our hospital, combining knowledge, skill and compassion to create a workforce that is caring, innovative, scientific and empowering. We share a commitment to delivering the highest quality patient care and excellence in clinical practice. The NP/PA is responsible for: • Performs and records the patient history and physical examination and discusses findings with the collaborating team. Obtaining and coordinating laboratory results, charting of clinical findings in the EMR, orders, nursing instructions, and other required elements. • Utilizes advanced practice knowledge to identify, prevent or solve complex and/or recurring breast oncology patient care problems. • Follows and manages patients (in collaboration with MD) enhancing continuity of care. • Performs (oversees/assures completion of) specialized procedures particular to the select medical oncology population mutually agreed upon with collaborating physician. • Collaborates with staff and physicians to facilitate a comprehensive plan of care and coordinate resources and write appropriate orders improving access to care, establishing goals for the delivery of care to patients, participating in clinical research, and managing communications between physicians, patients, family, and staff. • Appreciates complex medication interactions. • Ensuring appropriate diagnostic procedures occur in a timely matter through careful coordination with other services such as radiology, facilitating various clinic appointments, communicating with patients regarding test results, and providing coverage for the team. • Educating patients regarding a variety of medical oncology issues associated with local or systemic therapy. • Indications and interpretation of radiology, pathology, and laboratory results. • Understands the complex medical environments of cancer patients including, but not limited to, those with advanced malignancy or organ dysfunction. • Writes orders which are in accord with current guidelines including antineoplastics. • Maintains and practices in accord with practice guidelines per state and hospital regulations. • Provides consultation to both nurses and physicians and serves as a resource to staff in area(s) of expertise. • Collaborates with staff and other health care professionals to meet staff and patient educational needs. • Monitors patient outcomes in accordance with defined standards of patient care. • Supports and conducts research efforts to advance knowledge and to promote research-based practice. • Responsible for own professional growth and maintenance of required credentials. Qualifications • 2+ years advanced practice and medical oncology experience is preferred. • Prior oncology RN experience is preferred for NP applicants. • Proficiency with Epic and EMRs preferred. • EPIC In-basket management, telemedicine experience preferred. • Familiarity with clinical trials preferred. Working Conditions: • Ambulatory Clinic Setting within Boston-based academic medical centers and/or network sites Job Summary Summary The Nurse Practitioner (NP) is a licensed provider. The NP is responsible for the assessment and management of various populations of patients, medical and/or surgical, including diagnostic and therapeutic interventions, development of appropriate plans of care and ongoing evaluation. Does this position require Patient Care? Yes Essential Functions -Provides direct care, counseling, and teaching to a designated patient population in the ambulatory, inpatient, operative, and/or procedural setting -Performs complete histories and physical examinations -Orders, interprets, and evaluates appropriate laboratory and diagnostic tests -Develops appropriate plans of care and follow-up based on the outcomes of diagnostic, laboratory, and physical examination findings -Consistently provides high quality and timely documentation including admission and progress notes, procedure notes, operative notes and discharge summaries -Performs bedside procedures as are appropriate to the patient population -Orders medications and writes prescriptions according to organizational and regulatory policies and procedures Qualifications Education Master's Degree Nursing required Can this role accept experience in lieu of a degree? No Licenses and Credentials Registered Nurse [RN - State License] Advanced Practice Registered Nurse [APRN] [MA] preferred Experience Experience as a nurse practitioner 0-1 year preferred Knowledge, Skills and Abilities - Skilled in taking medical histories to assess medical condition and interpret findings. - Ability to maintain quality control standards. - Ability to react calmly and effectively in emergency situations. - Ability to interpret, adapt and apply guidelines and procedures. - Ability to communicate clearly and establish/maintain effective working relationships with patients, medical staff and the public. Additional Job Details (if applicable) Remote Type Hybrid Work Location 55 Fruit Street Pay Range $122,803.20 - $173,867.20/Annual Grade 7 At Mass General Brigham, we believe in recognizing and rewarding the unique value each team member brings to our organization. Our approach to determining base pay is comprehensive, and any offer extended will take into account your skills, relevant experience if applicable, education, certifications and other essential factors. The base pay information provided offers an estimate based on the minimum job qualifications; however, it does not encompass all elements contributing to your total compensation package. In addition to competitive base pay, we offer comprehensive benefits, career advancement opportunities, differentials, premiums and bonuses as applicable and recognition programs designed to celebrate your contributions and support your professional growth. We invite you to apply, and our Talent Acquisition team will provide an overview of your potential compensation and benefits package. EEO Statement: 1200 The General Hospital Corporation is an Equal Opportunity Employer. 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. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Veteran’s Readjustment Act of 1974, and Title I of the Americans with Disabilities Act of 1990, applicants who require accommodation in the job application process may contact Human Resources at (857)-282-7642. Mass General Brigham Competency Framework At Mass General Brigham, our competency framework defines what effective leadership “looks like” by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline. 
$90,000 - $120,000 / year
Job Summary: The Care Navigator is responsible for conducting telephonic interactions, documenting service activities, and supporting administrative functions that enhance member satisfaction. Care Navigators also contribute to core operations including intake, triage, scheduling coordination, provider and member engagement, centralized documentation, and escalations. Essential Functions: Conducts outreach to members and providers to confirm service details, coordinate scheduling, address general inquiries, and ensure accurate documentation of care coordination activities. Coordinate services by working with providers, community partners, and member/ caregivers to manage scheduling, service updates, and administrative changes, as needed Serves as a support resource for member and provider requests, escalations, or concerns by coordinating responses and ensuring issues are routed or addressed promptly Collaborates with the care team, providers, and other partners as needed to support member service requests and ensure smooth communication and continuity across care activities Initiate outreach to members, vendors, providers, and/or vendors/suppliers to follow up on non-clinical matters assigned by the Care Team (e.g., including authorization status, DME status, appointment scheduling and prescription assistance) Provide administrative support as assigned Assist members and the Care Team with solving health plan related concerns, i.e. claims follow up or prior auth status, etc. Help members schedule transportation to medical appointments; assist members with booking issues Support targeted member outreach campaigns when there is an event that has the potential to broadly impact our membership’s wellness, such as agency closures, hazardous/catastrophic events (e.g., power outages, fires, inundations) Coordinates interpreting and translation supporting services for the member (including ADA compliance) Obtain documents/forms that allow Care Team to speak with members and/or representatives on the member’s behalf in accordance with HIPAA laws – e.g., Release of Information (ROI), Oral Disclosure of Protected Health Information Assist leadership with the development, refinement and enhancement of programs, initiatives, processes, policies, workflows, and projects Mentor for new Care Navigation Specialist – during and beyond their orientation period, if needed Maintain accurate documentation and maintenance of member records and alignment with regulatory standards, ensuring timely distribution to appropriate internal teams or provider partners as needed Follow established standards of practice, internal policies, and procedures to ensure compliance with contractual obligations and applicable regulatory requirements Identify member and provider needs and facilitates referrals to appropriate internal teams such as care management or community-based support programs Performs any other job related duties as requested. Education and Experience: High School or GED required One (1) year of related experience in a health-related service field required Competencies, Knowledge and Skills: Critical thinking and troubleshooting skills Strong customer service and problem-solving skills Ability to work in multiple systems, often simultaneously Clear, concise, and effective oral and written communication Strong time management and demonstrated ability to work independently Flexibility to adapt to business needs Motivated team player Excellent organizational skills High attention to detail and accuracy Basic arithmetic skills required Proficiency in Microsoft Office Suite Licensure and Certification: None required Working Conditions: General office environment; may be required to sit or stand for extended periods of time Travel is not typically required Compensation Range: $90,000 - $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. $90,000 - $120,000 / year
Job Summary: The Clinical Care 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 Performs any other job related duties as requested. Education and Experience: 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, MA required Prior experience in care coordination, case management, or working with dual-eligible populations preferred Medicaid and/or Medicare managed care experience preferred 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), Licensed Clinical Social Worker (LCSW), Licensed Independent Clinical Social Worker (LISCW), or a Licensed Mental Health Counselor (LMHC) 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: $90,000 - $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. $90,000 - $120,000 / year
Job Summary: The Clinical Care 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 Performs any other job related duties as requested. Education and Experience: 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, MA required Prior experience in care coordination, case management, or working with dual-eligible populations preferred Medicaid and/or Medicare managed care experience preferred 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), Licensed Clinical Social Worker (LCSW), Licensed Independent Clinical Social Worker (LISCW), or a Licensed Mental Health Counselor (LMHC) 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: $90,000 - $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. $90,000 - $120,000 / year
Job Summary: The Clinical Care 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 Performs any other job related duties as requested. Education and Experience: 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, MA required Prior experience in care coordination, case management, or working with dual-eligible populations preferred Medicaid and/or Medicare managed care experience preferred 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), Licensed Clinical Social Worker (LCSW), Licensed Independent Clinical Social Worker (LISCW), or a Licensed Mental Health Counselor (LMHC) 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: $90,000 - $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. $90,000 - $120,000 / year
Job Summary: The Care Navigator is responsible for conducting telephonic interactions, documenting service activities, and supporting administrative functions that enhance member satisfaction. Care Navigators also contribute to core operations including intake, triage, scheduling coordination, provider and member engagement, centralized documentation, and escalations. Essential Functions: Conducts outreach to members and providers to confirm service details, coordinate scheduling, address general inquiries, and ensure accurate documentation of care coordination activities. Coordinate services by working with providers, community partners, and member/ caregivers to manage scheduling, service updates, and administrative changes, as needed Serves as a support resource for member and provider requests, escalations, or concerns by coordinating responses and ensuring issues are routed or addressed promptly Collaborates with the care team, providers, and other partners as needed to support member service requests and ensure smooth communication and continuity across care activities Initiate outreach to members, vendors, providers, and/or vendors/suppliers to follow up on non-clinical matters assigned by the Care Team (e.g., including authorization status, DME status, appointment scheduling and prescription assistance) Provide administrative support as assigned Assist members and the Care Team with solving health plan related concerns, i.e. claims follow up or prior auth status, etc. Help members schedule transportation to medical appointments; assist members with booking issues Support targeted member outreach campaigns when there is an event that has the potential to broadly impact our membership’s wellness, such as agency closures, hazardous/catastrophic events (e.g., power outages, fires, inundations) Coordinates interpreting and translation supporting services for the member (including ADA compliance) Obtain documents/forms that allow Care Team to speak with members and/or representatives on the member’s behalf in accordance with HIPAA laws – e.g., Release of Information (ROI), Oral Disclosure of Protected Health Information Assist leadership with the development, refinement and enhancement of programs, initiatives, processes, policies, workflows, and projects Mentor for new Care Navigation Specialist – during and beyond their orientation period, if needed Maintain accurate documentation and maintenance of member records and alignment with regulatory standards, ensuring timely distribution to appropriate internal teams or provider partners as needed Follow established standards of practice, internal policies, and procedures to ensure compliance with contractual obligations and applicable regulatory requirements Identify member and provider needs and facilitates referrals to appropriate internal teams such as care management or community-based support programs Performs any other job related duties as requested. Education and Experience: High School or GED required One (1) year of related experience in a health-related service field required Competencies, Knowledge and Skills: Critical thinking and troubleshooting skills Strong customer service and problem-solving skills Ability to work in multiple systems, often simultaneously Clear, concise, and effective oral and written communication Strong time management and demonstrated ability to work independently Flexibility to adapt to business needs Motivated team player Excellent organizational skills High attention to detail and accuracy Basic arithmetic skills required Proficiency in Microsoft Office Suite Licensure and Certification: None required Working Conditions: General office environment; may be required to sit or stand for extended periods of time Travel is not typically required Compensation Range: $90,000 - $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. 
