RN Case Manager

CareSource

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

Posted 9/23/2026full-timeSpringfield • 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 programs 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

Clinical AssessmentsCare Plan DevelopmentCrisis ManagementUtilization ManagementPreventive Health StrategiesRisk AssessmentCommunity Resource NavigationMedication Adherence EducationChronic Condition ManagementData Reporting

Soft Skills

Interpersonal SkillsCommunication SkillsCustomer Service SkillsDecision-Making SkillsProblem-Solving Skills

Tools & Technologies

Microsoft OfficeOutlookWordExcel

Certifications & Qualifications

Registered Nurse LicenseCase Management Certification

Industry Keywords

Dually Eligible PopulationsLong-Term Services and SupportsNCQA StandardsCommunity-Based CareHealth Care Transitions

About the role

Key responsibilities & impact

Provide monitoring, follow-up, and clinical care management to dually eligible enrollees with complex medical, behavioral, and social needs
Engage enrollees in 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, functional, crisis, and risk assessments
Develop and implement care plans with routine updates
Lead interdisciplinary care teams and collaborate with internal and external peers
Oversee utilization of long-term services and supports
Help members access 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, preventive care, and healthy lifestyle choices
Assist with preventive health strategies and gap closure
Follow up after hospitalizations and significant health events to promote continuity of care and prevent readmissions
Coordinate care with primary care physicians, specialists, healthcare providers, community organizations, state agencies, and service providers
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 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 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
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 work independently and effectively as part of an interdisciplinary team
Decision-making and problem-solving skills
Awareness and sensitivity to diverse backgrounds and needs
Valid driver's license, vehicle, and verifiable insurance
Successful driver's license record check required
Annual influenza vaccination required during influenza season
Must reside in the assigned territory and within commutable distance to the Commonwealth of Massachusetts
May be required to travel greater than 50% of the time
Flexible availability, including possible evenings and weekends
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

Bonus tied to company and individual performance may be available
Comprehensive total rewards package
Annual influenza vaccination provided/required as a condition of continued employment
Reasonable accommodations for disabilities, medical conditions, and sincerely held religious beliefs
Flexible hours, including possible evenings and/or weekends
Mobile work arrangement with travel to homes, offices, and public settings