RN Care Manager

CareSource

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

Posted 10/26/2026full-timeCambridge • 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, integrating health services and community resources to enhance health outcomes. Proficient in conducting assessments, developing care plans, and leading interdisciplinary teams while ensuring compliance with NCQA standards.

Highest-signal resume keywords

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

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Clinical Care ManagementCrisis and Risk AssessmentsCare Plan DevelopmentUtilization ManagementMedication Adherence EducationPreventive Care StrategiesCommunity Resource CoordinationData Entry and DocumentationHealth Outcome EvaluationMember Satisfaction Monitoring

Soft Skills

Interpersonal SkillsCommunication SkillsCustomer Service SkillsDecision-Making SkillsProblem-Solving Skills

Tools & Technologies

Microsoft Office SuiteElectronic Health Records (EHR)Care Management Software

Certifications & Qualifications

Case Management CertificationRegistered Nurse LicenseAnnual Influenza Vaccination

Industry Keywords

Dually Eligible PopulationsLong-Term Services and SupportsCommunity-Based CareNCQA StandardsHealthcare Provider Liaison

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
Integrate health services and community resources to coordinate enrollee care and improve health outcomes and quality of life
Engage enrollees in homes and community settings to establish complex care management relationships
Serve as liaison between healthcare providers, community resources, and enrollees
Perform Comprehensive, MDS-HC or successor Functional, and Crisis and Risk Assessments
Develop and implement care plans with enrollees and provide routine updates
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, Medicaid, 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 and 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
Evaluate member satisfaction and monitor concerns
Conduct regular member, provider, and community-based visits
Report abuse, neglect, or exploitation as a mandated reporter under state law
Adhere to NCQA and Care Management standards
Perform 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
Registered Nurse with the ability to independently serve people with complex medical, behavioral, and social needs
Current unrestricted clinical license in the Commonwealth of Massachusetts as a Registered Nurse (RN) required
Valid driver's license, vehicle, and verifiable insurance
Successful clearance of a driver's license record check
Annual influenza vaccination during influenza season as a condition of continued employment
Intermediate proficiency with Microsoft Office, including Outlook, Word, and Excel
Understanding of Medicare and Medicaid programs and community resources for dual-eligible beneficiaries
Strong interpersonal, communication, customer relations, and customer service skills
Ability to manage multiple cases and priorities while maintaining attention to detail
Ability to function independently and effectively as part of an interdisciplinary team
Decision-making and problem-solving skills
Must reside in the assigned territory
Must live within commutable distance to the Commonwealth of Massachusetts
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

$10,000 sign-on bonus
Bonus tied to company and individual performance may be available
Comprehensive total rewards package
Total well-being support
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 provided/required as part of continued employment protections