Registered Nurse (RN) Clinical Care Manager

CareSource

. Provide monitoring, follow-up, and clinical care management to dually eligible enrollees with complex medical, behavioral, and social care needs .

Posted 9/21/2026full-timeWilbraham • Massachusetts • United StatesMid-LevelSenior💰 $80,000 - $120,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in care management for dually eligible enrollees, including comprehensive assessments, care plan development, and interdisciplinary collaboration. Proficient in navigating Medicare and Medicaid systems while advocating for member needs and ensuring continuity of care.

Highest-signal resume keywords

Registered Nurse (RN)Care CoordinationMedicare and Medicaid KnowledgeCase Management CertificationInterdisciplinary Team Collaboration

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Comprehensive AssessmentsCare Plan DevelopmentCrisis AssessmentRisk AssessmentUtilization ManagementChronic Condition ManagementPreventive Health StrategiesMember Satisfaction EvaluationCommunity Resource LiaisonHealth Education

Soft Skills

Strong Communication SkillsInterpersonal SkillsCustomer Service SkillsAttention to DetailAbility to Manage Multiple Cases

Tools & Technologies

Microsoft OfficeOutlookWordExcel

Certifications & Qualifications

Case Management CertificationRegistered Nurse LicenseDriver's License

Industry Keywords

Dually EligibleLong-Term Services and SupportsNCQA StandardsCommunity-Based TrainingHealthcare Advocacy

About the role

Key responsibilities & impact

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, MDS-HC or successor Functional, Crisis, and Risk Assessments
Develop and implement care plans with enrollees and provide updates as statuses change
Lead interdisciplinary care teams and collaborate with internal and external peers
Oversee utilization of long-term services and supports
Assist members with housing, transportation, food assistance, and social services
Educate members about Medicare and Medicaid benefits and available services
Educate members and families about chronic-condition management, medication adherence, and preventive care
Promote healthy lifestyle choices and self-management strategies
Support preventive health strategies and gap closure
Follow up after hospitalizations or significant health events to ensure continuity of care and prevent readmissions
Coordinate care with primary care physicians, specialists, healthcare providers, community organizations, state agencies, and other stakeholders
Advocate for enrollee needs and preferences within the healthcare system
Evaluate member satisfaction and monitor concerns
Conduct regular member, provider, and community-based visits, with travel potentially exceeding 50% of working time
Report abuse, neglect, or exploitation as a mandated reporter under state law
Adhere to NCQA and Care Management standards
Perform other related duties as requested

Requirements

What you’ll need

Associates of Science (A.S) degree in nursing from an accredited nursing program required
Registered Nurse with the ability to independently serve people with complex medical, behavioral, and social needs required
Current unrestricted clinical license in the Commonwealth of Massachusetts as a Registered Nurse (RN) required
Must have valid driver's license, vehicle and verifiable insurance
Successful clearance of a driver's license record check required
Annual influenza vaccination required during influenza season as a condition of continued employment
Must reside in the same assigned territory; exceptions may be considered due to business need
Must live within commutable distance to the Commonwealth of Massachusetts
Intermediate proficiency with Microsoft Office, including Outlook, Word and Excel
Understanding of Medicare and Medicaid programs, community resources, and services available to dual-eligible beneficiaries
Strong written and verbal communication, interpersonal, customer relations, and customer service skills
Ability to manage multiple cases and priorities while maintaining attention to detail
Ability to function independently and as part of an interdisciplinary team
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
Case Management Certification highly preferred

Benefits

Comp & perks

$5K sign-on bonus
Bonus tied to company and individual performance may be available
Comprehensive total rewards package
Flexible hours, including possible evenings and/or weekends
Reasonable accommodations for qualified individuals with disabilities, medical conditions, or sincerely held religious beliefs
Annual influenza vaccination requirement with employer verification during influenza season