RN Jobs in Somerville, MA
$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. 
