Clinical Care Manager Nurse

Site: Mass General Brigham Health Plan Holding Company, Inc.

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.

Community-based Clinical Care Manager, Registered Nurse for our Duals plans, we are hiring for three Clinical Care Managers within our communities!

The Clinical Care Manager Nurse requires an active RN license and the ability to accommodate a hybrid work model that requires travel in the area M-F, including practice-based, remote work, and in-person home and community visits to Duals members. The ideal candidate will reside in Eastern, MA area, given our membership.

Clinical Care Managers (3 total) will be geographically aligned, within proximity, as member enrollment progresses. 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.

Job Summary

The Opportunity

Mass General Brigham Health Plan seeks a Registered Nurse (RN) Clinical Care Manager to work as part of an interdisciplinary care team providing care management for health plan enrollees with complex medical, behavioral, and social needs, including Severe and Persistent Mental Illness (SPMI).

As a clinical expert on the interdisciplinary team, the Clinical Care Manager conducts assessments, develops enrollee centered care plans, coordinates care, provides health education, and collaborates with providers to ensure comprehensive support.

This position requires an active RN license and a hybrid working model, including practice-based, remote work and enrollee in-person home and community visits as needed.

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

What You'll Do:

• Collaborate with the interdisciplinary care team-including LTSC, GSSC, primary care providers, and specialists-to support program enhancements, process improvements, and comprehensive care coordination.
• Participate in interdisciplinary care team meetings, ensuring medication reconciliation, timely follow-ups after hospitalization, quality gap closures, and consistent communication with providers and enrollees.
• Develop, update, and implement individualized, enrollee-centered care plans in collaboration with enrollees and the care team, incorporating self-care, shared decision-making, and addressing behavioral health needs.
• Conduct outreach, assessments, and home visits using telephonic, electronic, or in-person methods to evaluate clinical status, identify needs, and provide ongoing community-based care management or appropriate referrals.
• Monitor enrollees' clinical status for early signs of deterioration, proactively intervene to prevent unnecessary hospitalizations, and act as the clinical escalation point for urgent issues through triage, telephonic support, and care coordination.
• Provide health education, coaching, and routine engagement to assigned enrollees, proactively addressing questions, concerns, and facilitating access to providers and supportive services.
• Utilize electronic medical record systems to accurately document, monitor, and evaluate enrollee interventions and care plans, ensuring compliance with DSNP regulations and internal policies.
• Serve as a clinical resource and lead interdisciplinary care team member for assigned enrollees, supporting compliance initiatives, quality assurance, and collaborating with care management leadership on challenging cases.
• Perform additional duties as assigned by supervisors to support care management goals and promote enrollee well-being.

Qualifications

Qualifications

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

Additional Job Details (if applicable)

Working Model Required

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

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

The population will primarily include enrollees residing in Essex, Middlesex, Suffolk, 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, 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:

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.