Clinical Care Manager Mass General Brigham Health Plan

Clinical Care Manager, Registered Nurse

Community based Clinical Care Manager, Registered Nurse for our expanding team, we are hiring for three Clinical Care Managers within our communities! The Clinical Care Manager requires an active RN license and ability to accommodate our hybrid work model requires travel in the area M-F, including practice-based, remote work and enrollee in-person home and community visits. Residing in Eastern, MA area ideally. Clinical Care Managers (3 total) will be geographically aligned, within proximity as member enrollment progresses. Population will primarily include enrollees residing in Essex, Middlesex, Suffolk, Norfolk, Plymouth, Bristol, Dukes, and Nantucket counties. The Clinical Care Manager's responsibilities and caseload may be adjusted based on enrollee enrollment trends.

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 teamincluding LTSC, GSSC, primary care providers, and specialiststo 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
• Bachelor's Degree Nursing preferred
• Registered Nurse [RN - State License] required
• Basic Life Support [BLS Certification] preferred
• At least 2-3 years experience in health plan or community case management highly preferred
• Experience with Dual Eligible Populations (Medicare and Medicaid) preferred
• Certified Case Management Certification preferred

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
• Onsite Practice-based, remote work and enrollee in-person home and community visits
• Weekly multiple days in field needed, will vary
• 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 member's needs. With flexibility required based on member needs
• The Clinical Care Manager must be flexible for training, field work and business needs, this can vary 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 Clinical Care Manager requires an active RN license and accommodating the hybrid work model, including practice-based, remote work and enrollee in-person home and community visits.

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

Remote Type: Hybrid

Work Location: 399 Revolution Drive

Scheduled Weekly Hours: 40

Employee Type: Regular

Work Shift: Day (United States of America)

Pay Range: $58,656.00 - $142,448.80/Annual

Grade: 98TEMP

At Mass General Brigham Health Plan Holding Company, Inc., 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.

Mass General Brigham Health Plan Holding Company, Inc. 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.