Clinical Care Manager

• Provide monitoring, follow-up, and clinical care management to dually eligible enrollees with complex medical, behavioral, and social care needs
• Engage enrollees in their homes and community settings to establish complex care management relationships
• Liaise between healthcare providers, community resources, and enrollees to support communication and care transitions
• Perform comprehensive, functional, crisis, and risk assessments
• Develop and implement care plans, providing updates as enrollee status changes
• Lead interdisciplinary care teams and create holistic care plans addressing medical and non-medical needs
• Oversee utilization of long-term services and supports
• Help members access housing, transportation, food assistance, and social services
• Educate members and families about Medicare, Medicaid, chronic conditions, medication adherence, preventive care, and self-management
• Assist with preventive health strategies and gap closure
• Follow up after hospitalizations and significant health events to support continuity and prevent readmissions
• Coordinate care with physicians, specialists, healthcare providers, community organizations, state agencies, and other stakeholders
• Advocate for enrollee needs and preferences and evaluate member satisfaction
• Conduct regular member, provider, and community-based visits
• Report abuse, neglect, or exploitation as a mandated reporter
• Adhere to NCQA and Care Management standards
• Perform other job-related duties as requested

Requirements

• Master's degree in social work or mental health counseling and independent license required
• Ability to independently serve people with complex medical, behavioral, and social needs
• Prior experience in care coordination, case management, or working with dual-eligible populations preferred
• Medicaid and/or Medicare managed care experience preferred
• Clinical field/community-based training is a plus
• Intermediate proficiency with Microsoft Office, including Outlook, Word, and Excel
• Understanding of Medicare and Medicaid programs and community resources for dual-eligible beneficiaries
• Strong interpersonal, written, and verbal communication skills
• Ability to manage multiple cases and priorities while maintaining attention to detail
• Adherence to a professional code of ethics
• Awareness and sensitivity to diverse backgrounds and population needs
• Decision-making and problem-solving skills
• Ability to function independently and as part of an interdisciplinary team
• Licensed Clinical Social Worker (LCSW), Licensed Independent Clinical Social Worker (LISCW), or Licensed Mental Health Counselor (LMHC) required
• Case Management Certification highly preferred
• Valid driver's license, vehicle, and verifiable insurance required
• Successful driver's license record check required
• Influenza vaccination required during designated influenza season
• Must reside in the assigned territory and within commutable distance to Massachusetts
• Must be able to travel over 50% of the time / regular travel required
• Flexible availability, including possible evenings and weekends

Core Competencies

Demonstrates expertise in care coordination and management for dually eligible populations, with a strong understanding of Medicare and Medicaid programs. Capable of developing and implementing comprehensive care plans while effectively engaging with interdisciplinary teams and community resources.

Highest-signal resume keywords

• Licensed Clinical Social Worker (LCSW)
• Care Coordination
• Medicaid Experience
• Medicare Experience
• Case Management Certification

ATS Optimization Keywords

Hard Skills

• Complex Care Management
• Crisis Assessment
• Risk Assessment
• Care Plan Development
• Utilization Management
• Preventive Health Strategies
• Community Resource Liaison
• Interdisciplinary Team Leadership
• Member Advocacy
• Data Reporting

Soft Skills

• Interpersonal Communication
• Decision-Making
• Problem-Solving
• Attention to Detail
• Cultural Sensitivity

Certifications & Qualifications

• Licensed Independent Clinical Social Worker (LISCW)
• Licensed Mental Health Counselor (LMHC)
• Case Management Certification

Industry Keywords

• Dual-Eligible Populations
• Healthcare Providers
• Community-Based Training
• NCQA Standards
• Social Services
• Preventive Care
• Medication Adherence
• Continuity of Care
• Housing Assistance
• Transportation Services

Tools & Technologies

• Microsoft Office
• Outlook
• Word
• Excel