11,067 Clinical Care Manager jobs in the United States

• Supervise and support direct care staff to ensure compliance with policies and regulations.
• Manage a caseload of clients, develop personalized treatment plans, and coordinate care with external providers.
• Conduct comprehensive assessments and supervisory visits, documenting care plans in line with agency standards.
• Lead orientation, training, and competency verification for new hires.
• Act as a liaison among staff, community, and healthcare providers to ensure seamless communication.
• Provide in field supervision and real-time guidance to clinicians.
• Participate in quality assurance, performance improvement, and staff development initiatives.
• Support on-call operations, ensuring timely follow-up and accurate documentation.

• 1+ years healthcare experience preferred
• Degree from an accredited school of nursing
• Registered Nurse required
• Home health or pediatric experience preferred
• Bilingual in Spanish preferred (but not required)

• Competitive Pay
• Paid Time Off
• Medical, Dental, & Vision Plans with a generous contribution from AOC
• HSA/FSA
• Mental Wellness Benefits
• 401K
• Discounts on Pet, Home, and Auto Insurance
• And more!

Job DescriptionIt's an exciting time to join the WellSense Health Plan, a growing regional health insurance company with a 25-year history of providing health insurance that works for our members, no matter their circumstances.Job SummaryThe Clinical Care Manager provides holistic medical care management services for members throughout the continuum of care by assessing the member clinically as well as member's readiness to make behavioral changes and actively participate in a care plan, establish goals and meet those goals. Members may include those who have chronic conditions and complex care needs, including those considered to be the highest risk members those who are homeless, undergoing organ transplantation, have multiple clinical and behavioral co-morbid conditions, and with special health care needs. The clinician works collaboratively with a multidisciplinary team (both internal and external) including providers, our clinical vendor partners (behavioral health, pharmacy, etc.) and community/ State agencies to increase patient knowledge, motivation, and compliance with treatment through targeted interventions that address the member's holistic needs from a medical and psychosocial/socioeconomic standpoint. Following this approach, the goal is to improve member health outcomes and decrease overall cost while improving the member's overall experience with the health care delivery system.Utilizing both telephonic outreach and face to face member visits and through the use of assessments, real-time data, motivational interviewing techniques and evidence-based practices, the Clinical Care Manager engages with the member and the multidisciplinary team to develop an Individual Care Plan (ICP) that emphasizes self-management goals, care coordination, psychosocial, socioeconomic, and community-based supports and on-going monitoring and appropriate follow up. The Clinical Care Manager identifies and addresses barriers to optimal self-management and works with the member, their support persons, and team to coordinate care throughout the health care continuum, assisting the member to access all available benefits and resources including family support and community resources, with a goal of promoting appropriate utilization of services at the appropriate level and site of care such as preventing ambulatory sensitive emergency department visits and inpatient admissions, avoiding readmissions, and encouraging the member to keep scheduled outpatient appointments to include preventive care visits. The clinical care manager may meet members in their homes, shelters, provider offices, medical facilities, and at locations agreed upon with the member. Our Investment in You:Full-time remote workCompetitive salariesExcellent benefitsKey Functions/ResponsibilitiesCompletes a targeted general assessment and applicable condition specific assessments.Evaluates members' need for complex care management, disease management or chronic condition management.Collaboratively develops an individual care plan with the member focusing on the member's goals and objectives, identifying strategies, supports and/or services needed to achieve short and long term goals.Identifies and addresses barriers to optimal self-management and works with the member and team to coordinate care throughout the health care continuum.Assists the member to access all available benefits and resources including family support and community resources.Utilizes motivational interviewing techniques to engage members in care management and to coach members regarding health promotion, disease management and preventive health strategies.Uses real-time data from electronic medical records, where available.Uses reporting to access member medical and pharmacy utilization reports, sharing with PCP, to promote medication compliance and action plans.Supports and enhances the member's capacity to self-manage.Evaluates the effectiveness of the care management provided to the member on an on-going basis and updates the ICP accordingly.Utilizes evidence-based practices and guidelines to educate members on specific disease processes.Provides or arranges for resources necessary to meet members' social determinants of health care needs including but not limited to psychosocial and socioeconomic needs.Promotes and encourages member collaboration with the primary care provider and other health care providers.Completes documentation in the medical management information system real-time during face-to-face meetings, by phone, and in a timely manner and in keeping with contractual requirements, internal policy and NCQA accreditation standards. Facilitates multidisciplinary consultation on members' behalf through participation in rounds, team meetings and clinical reviews.Conducts face-to-face visits with members and providers, community and state agencies, as appropriate.Regular and reliable transportation and the ability to conduct face-to-face appointments with members, providers, community and state agenciesAssists with staff training and mentoring.Refers cases to Social Care Management, Behavioral Health Care Management, and Community Health Worker staff, as clinically indicated. Consults with and refers members to the multidisciplinary team, as appropriate. Coordinates member care transitions through pre-admission assessments, post-discharge assessment and follow-up to ensure appointment is made with the PCP or Specialist; assessing for home health services, DME needs, and transportation issues; performing medication reconciliation; ensuring compliance with discharge plan, appointments and medication regimen. Uses available standardized educational materials in an appropriate reading level and language to educate members about their conditions. Monitor members' labs, tests results, appointments and other data in order to best coordinate care utilizing EMR (where available and appropriate) and the Plan's care management software. Maintains HIPPA standards and confidentiality of protected health information. Demonstrates strong knowledge of contractual requirements of all products and provides cross coverage across product lines when needed. Adheres to departmental/organizational policies and procedures. Provide Care Management services and care coordination of Infants diagnosed with low birth weight and/or neonatal abstinence syndrome (NAS) in regard to physical and behavioral health care needs. Coordination with the family / legal guardian and Providers on the development of the Plan of Safe Care for any infant born with NAS Increase the timeliness of prenatal care, particularly for Members at risk of having a child with low birth weight or NAS Attend in-person care team meetings with providers, DCYF, and other key stakeholders in the community or in the hospital setting. Attend in person community based meetings to stay current on prenatal, post-partum, and care for NOWS. Other duties as assigned.Supervision ReceivedRegularly scheduled meetings with Manager of Care ManagementQualificationsEducation Required:Bachelor's degree in nursing or Associate's degree in Nursing and relevant work experience.Experience Required:3 years related experience in home health care or managed care organization3 years clinical experience with members who have multiple, chronic or complex health conditions 2 years' experience in care management, care coordination and/or discharge planningExperience Preferred/Desirable:Experience working with Medicaid recipients and community servicesExperience with FACETS, Jiva, Interqual or other healthcare databaseCCM certification preferredRequired Licensure, Certification or Conditions of Employment: Pre-employment background checkCurrent unrestricted, applicable, state license to practice as a Registered NurseRegular and reliable transportation and the ability to conduct face-to-face appointments with members, providers, community and state agenciesCompetencies, Skills, and Attributes: Strong Motivational Interviewing skillsStrong oral and written communication skillsAbility to effectively collaborate with health care providers and all members of the multidisciplinary team Demonstrated organizational and time management skillsAble to work in a fast paced environment Experience with Microsoft Office application, particularly MS Outlook and MS Word and other data entry processing applicationsStrong analytical and clinical problem solving skillsStrong technical skills and ability to document in the Plan's care management documentation system in real-time when meeting with members and providers in-person or by phone.Working Conditions and Physical EffortRegular and reliable attendance is an essential function of the position.Work may be performed in a typical interior/office work environment or in a home office except when conducting face-to-face visits.Face-to-face visits may be conducted in a member's home, shelters, physician practices, hospitals, or at a mutually agreed upon location between the member and the care manager and also with community and state agencies, as appropriate.No or very limited physical effort required. No or very limited exposure to physical risk.About WellSenseWellSense Health Plan is a nonprofit health insurance company serving more than 740,000 members across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans. Founded in 1997, WellSense provides high-quality health plans and services that work for our members, no matter their circumstances. WellSense is committed to the diversity and inclusion of staff and their members. WellSense is committed to the diversity and inclusion of staff and their members.Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status. WellSense participates in the E-Verify program to electronically verify the employment eligibility of newly hired employees

• Supervise and support direct care staff to ensure compliance with policies and regulations.
• Manage a caseload of clients, develop personalized treatment plans, and coordinate care with external providers.
• Conduct comprehensive assessments and supervisory visits, documenting care plans in line with agency standards.
• Lead orientation, training, and competency verification for new hires.
• Act as a liaison among staff, community, and healthcare providers to ensure seamless communication.
• Provide in field supervision and real-time guidance to clinicians.
• Participate in quality assurance, performance improvement, and staff development initiatives.
• Support on-call operations, ensuring timely follow-up and accurate documentation.

• 1+ years healthcare experience preferred
• Degree from an accredited school of nursing
• Registered Nurse required
• Home health or pediatric experience preferred

• Competitive Pay
• Paid Time Off
• Medical, Dental, & Vision Plans with a generous contribution from AOC
• HSA/FSA
• Mental Wellness Benefits
• 401K
• Discounts on Pet, Home, and Auto Insurance
• And more!

Company OverviewWelby Health is a rapidly scaling digital healthcare organization at the forefront of tech-enabled care management. We deliver exceptional patient experiences by integrating compassionate clinical teams with scalable infrastructure and enterprise-grade partnerships. As we expand our national client footprint, we are seeking a Clinical Care Manager to deliver high-quality remote care, coordinate multidisciplinary workflows, and drive measurable outcomes across our remote physiological monitoring program.Position SummaryThe Clinical Care Manager will serve as a key member of the Clinical Operations Department. This individual will provide ongoing remote care management for patients enrolled in remote physiological monitoring, leveraging Welby Health's platform to monitor vitals, develop individualized care plans, and deliver education and coaching that improve adherence and outcomes. The Clinical Care Manager will collaborate closely with physicians and cross-functional teams to ensure timely interventions, seamless care coordination, and an excellent patient experience.This position is suited for a licensed nurse who excels at patient communication, clinical decision-making, and working in a technology-enabled, remote environment.Key ResponsibilitiesPatient Monitoring & OversightMonitor and interpret patient vitals, assessments, and alerts within Welby Health's platform;Provide timely, evidence-based guidance and escalate clinically significant findings;Document accurately and completely in accordance with internal protocols and regulatory standards.Care Planning & CoordinationDevelop, implement, and adjust individualized care plans that address clinical and social needs;Coordinate with physicians, specialists, and community resources to close gaps in care;Serve as a liaison between patients and providers to improve engagement and adherence.Patient Education & SupportDeliver education and coaching via telephone, and secure messaging;Empower patients to manage chronic conditions and build sustainable health habits;Identify barriers to care and address them through practical, patient-centered solutions.Required ExperienceMust reside in the United States of America and be legally authorized to work without employer visa sponsorship, now or in the future;Active and valid registered nurse, licensed vocational nurse, or licensed practical nurse license;Bachelor's degree in nursing closely related healthcare field;Exceptional written and verbal communication skills;Ability to work independently in a remote, technology-driven environment;Excellent organization, attention to detail, and follow-through.Preferred ExperienceExperience in case management, chronic care management, and/or telehealth;Bilingual or multilingual proficiency;Familiarity with remote physiological monitoring, electronic medical record or electronic health record systems, or patient engagement tools.What We OfferHybrid and flexible work environment;Comprehensive medical, dental, vision, and 401(k) benefits with employer matching;Unlimited paid time off;Strategic opportunities to contribute within a mission-driven, scaling healthcare organization.

• Lead, supervise, and mentor a multidisciplinary team of care providers.
• Develop, implement, and monitor individualized care plans for clients.
• Conduct regular assessments of client needs and progress, adjusting care plans as necessary.
• Coordinate with internal and external stakeholders, including healthcare providers, government agencies, and community resources, to ensure seamless service delivery.
• Ensure adherence to all organizational policies, procedures, and legal/ethical guidelines.
• Manage case files, documentation, and reporting requirements accurately and efficiently.
• Provide crisis intervention and support to clients and staff as needed.
• Facilitate staff training and professional development opportunities.
• Contribute to program development and strategic planning to enhance service effectiveness.
• Act as a liaison between clients, families, and the organization.
• Maintain a safe and supportive environment for both clients and staff.

• Master's degree in Social Work (MSW) or a related field from an accredited institution.
• Valid LCSW or equivalent clinical licensure in California.
• Minimum of 7 years of progressive experience in social work or community care, with at least 3 years in a supervisory or management capacity.
• Extensive knowledge of case management, mental health services, and community resources in the **Sacramento, California, US** area.
• Demonstrated experience in developing and implementing care plans and outcome-based programs.
• Strong leadership, team-building, and conflict-resolution skills.
• Excellent written and verbal communication abilities.
• Proficiency in electronic health records (EHR) systems and case management software.
• Deep understanding of ethical practices and confidentiality in social work.
• Commitment to social justice and a passion for serving underserved communities.

• Developing, implementing, and monitoring individualized care plans for clients.
• Assessing client needs and coordinating with multidisciplinary healthcare teams.
• Providing direct support and case management services to clients and their families.
• Supervising and managing a team of community support workers.
• Ensuring compliance with regulatory standards and organizational policies.
• Liaising with external agencies and stakeholders to facilitate comprehensive care.
• Maintaining accurate and up-to-date client records and documentation.
• Offering guidance and support to clients navigating the healthcare system.

• Registered Nurse (RN) or Licensed Clinical Social Worker (LCSW) preferred.
• Bachelor's degree in Nursing, Social Work, or a related field.
• 3+ years of experience in a clinical or social care setting, with case management responsibilities.
• Demonstrated experience in leadership or supervisory roles.
• Knowledge of community resources and healthcare regulations.
• Excellent communication, interpersonal, and organizational skills.
• Proficiency in electronic health record (EHR) systems.

• Bachelor's degree in Nursing (RN), Social Work (BSW/MSW), Public Health, or a related field.
• Minimum of 4 years of experience in clinical practice, case management, or community health.
• Experience working with diverse populations and understanding of social determinants of health.
• Strong knowledge of healthcare systems, community resources, and patient advocacy.
• Excellent assessment, care planning, and motivational interviewing skills.
• Proficiency in electronic health records (EHR) systems and case management software.
• Strong organizational and documentation skills.
• Licensure/certification as appropriate for the degree (e.g., RN license, LCSW) is highly desirable.

Position Purpose: Assists in developing, assessing, and coordinating holistic care management activities to enable quality, cost-effective healthcare outcomes. May develop or assist with developing personalized service care plans/service plans for long-term care members and educates members and their families/caregivers on services and benefits available to meet member needs.