Registered Nurse (RN), Clinical Care Manager

CareSource

Registered Nurse managing clinical care for dually-eligible enrollees in Massachusetts. Engaging with community resources to coordinate care and improve health outcomes while promoting healthy lifestyle choices.

Posted 7/13/2026full-timeMassachusetts • 🇺🇸 United StatesMid-LevelSenior💰 $90,000 - $120,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in care coordination and case management for dual-eligible populations, with a strong understanding of Medicare and Medicaid programs. Capable of leading interdisciplinary teams to develop and implement holistic care plans while advocating for enrollees' needs.

Highest-signal resume keywords

Registered Nurse (RN)Care CoordinationCase Management CertificationMedicare and Medicaid ExperienceCommunity Resource Navigation

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Comprehensive AssessmentMDS-HC Functional AssessmentCrisis and Risk AssessmentPreventive Health StrategiesChronic Condition Management

Soft Skills

Cultural SensitivityCommunicationAdvocacyAttention to DetailInterpersonal Skills

Tools & Technologies

Microsoft OfficeOutlookWordExcel

Certifications & Qualifications

Case Management CertificationCurrent RN License in Massachusetts

Industry Keywords

Dual-Eligible PopulationsLong-Term Services and SupportsHealthcare Provider LiaisonCommunity-Based OrganizationsNCQA Standards

About the role

Key responsibilities & impact

Engage with the enrollee in their homes and other community settings to establish an effective, complex care management relationship, while considering the cultural and linguistic needs of each member.
Function as a liaison between healthcare providers, community resources, and enrollees to ensure seamless communication and care transitions.
Perform required assessments on a timely basis, including but not limited to Comprehensive Assessment, MDS-HC (or successor) Functional Assessments, and Crisis and Risk Assessments.
Engage enrollees in care plan development and implementation, providing routine updates as the enrollee’s status changes.
Lead the interdisciplinary care team (ICT) and collaborate with peers both internal and external to the organization, to create holistic care plans that address medical and non-medical needs.
Oversee enrollee utilization of long-term services and supports, ensuring appropriate systems are in place for enrollees to remain in the location of their choice.
Assist members in accessing community resources, including housing, transportation, food assistance, and social services.
Educate members about their benefits and available services under both Medicare and Medicaid.
Provide education to members and their families about managing chronic conditions, medication adherence, and preventive care.
Promote healthy lifestyle choices and self-management strategies.
Assist enrollees in preventative health strategies, including gap closure.
Follow up with members after hospitalizations or significant health events to ensure continuity of care and prevent readmissions.
Work closely with primary care physicians, specialists, and other healthcare providers to coordinate care and share relevant information.
Coordinate with community-based organizations, other stakeholders/entities, state agencies, and other service providers to ensure coordination and avoid duplication of services.
Advocate for the needs and preferences of enrollees within the healthcare system.
Evaluate member satisfaction through open communication and monitoring of concerns or issues.
Regular travel to conduct member, provider and community-based visits as required.
Report abuse, neglect, or exploitation of older adults and adults with disabilities as a mandated reporter as required by State law.
Adhere to NCQA and Care Management standards.
Perform any other job related duties as requested.

Requirements

What you’ll need

Associates of Science (A.S) degree in nursing from an accredited nursing program required
A Registered Nurse with the ability to independently serve people with complex medical, behavioral, and social needs required
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 a Plus
Intermediate proficiency level with Microsoft Office, including Outlook, Word and Excel.
Understanding of Medicare and Medicaid programs, as well community resources and services available to dual-eligible beneficiaries.
Ability to manage multiple cases and priorities while maintaining attention to detail.
Awareness of and sensitivity to the diverse backgrounds and needs of the populations served
Current unrestricted clinical license in the Commonwealth of Massachusetts as a Registered Nurse (RN) required
Case Management Certification is highly preferred

Benefits

Comp & perks

Health insurance
401(k)
Flexible working hours
Paid time off
Remote work options
Annual proof of Influenza vaccination required