Registered Nurse Clinical Care Manager

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.

Job Summary

Given equity, this position will pay somewhere between $90,000 to $110,000 annually.

Mass General Brigham Health Plan is an exciting place to be within the healthcare industry. As a member of Mass General Brigham, we are at the forefront of transformation with one of the world’s leading integrated healthcare systems. Together, we are providing our members with innovative solutions centered on their health needs to expand access to seamless and affordable care and coverage.

Our work centers on creating an exceptional member experience – a commitment that starts with our employees. Working with some of the most accomplished professionals in healthcare today, our employees have opportunities to learn and contribute expertise within a welcoming and supportive environment that embraces their unique and varied backgrounds, experiences, and skills.

We are pleased to offer competitive salaries and a benefits package with flexible work options, career growth opportunities, and much more.

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 member-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 member 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.  ​

Essential Functions:
-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 members’ 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
• Massachusetts Registered Nurse (RN) license required
• 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

• This is a full-time position with a schedule of Monday through Friday, 8:30 AM-5:00 PM EDT
• This is a hybrid schedule, which includes practice-based work, remote work, and in-person home and community visits (these days will vary weekly, and these visits may increase as member trends evolve)
• Must be local, ideally in Eastern, MA, with the ability to travel to the community.
• This role offers autonomy to build own schedule to accommodate members’ needs.
• Remote working days require a stable, quiet, secure, compliant working station and access to Teams Video via MGB equipment

Our goal will be to geographically align employees; this depends on residence and can vary based on business needs, member enrollment, and team staffing.Employees must accommodate the hybrid work model, including practice-based work, remote work, and in-person home and community visits with members.

The member population will reside primarily in Norfolk, Plymouth, Bristol, Dukes, and Nantucket counties. The responsibilities and caseload may be adjusted based on enrollment trends.   ​

Attachments

Hybrid399 Revolution Drive40RegularDay (United States of America)

Pay Range

$58,656.00 - $142,448.80/Annual

Grade

98TEMPAt 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.8925 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