RN Care Manager

Simple Staffing Group

Community-based RN responsible for care management of dually-eligible enrollees with complex needs. Engaging and coordinating with healthcare providers and community resources for improved health outcomes.

Posted 8/1/2026full-timeBoston • Massachusetts • 🇺🇸 United StatesMid-LevelSeniorWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in care coordination and case management, with a strong focus on engaging enrollees in their care plans and addressing their medical and non-medical needs. Proficient in navigating Medicare and Medicaid systems while advocating for enrollees' preferences and ensuring continuity of care.

Highest-signal resume keywords

Registered NurseCare CoordinationCase ManagementMedicaid ExperienceMedicare Experience

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Comprehensive AssessmentMDS-HC Functional AssessmentCrisis AssessmentRisk AssessmentChronic Condition ManagementPreventive Care StrategiesGap Closure StrategiesCommunity Resource AccessHealth EducationUtilization Management

Soft Skills

Effective CommunicationAdvocacyInterpersonal SkillsTeam CollaborationCultural Competence

Certifications & Qualifications

Associates of Science (A.S) in Nursing

Industry Keywords

Dual-Eligible PopulationsLong-Term Services and SupportsNCQA StandardsCare Management StandardsCommunity-Based Organizations

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.
Adherence 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

Benefits

Comp & perks

Health insurance
Paid time off
Dental insurance
401(k)
Vision insurance
Tuition reimbursement
Flexible schedule
Life insurance
401(k) matching
Health savings account