Community Registered Nurse (RN) Care Manager

Matter Health; Springfield (SD); On-site; USD 70,000 - 100,000; Full time

Benefits offered by this job

Medical, dental, vision insurance

Employer-funded HSA options

Employer-paid life and disability ins.

Optional supplemental insurance plans

Access to Matter Health care services

401(k) with company match

Paid time off

Holidays

Volunteer days

Job summary

Matter Health is hiring a Registered Nurse Care Manager to work in community-based settings, partnering with Care Teams to deliver coordinated, relationship-focused care for older adults in affordable housing. This role extends beyond bedside nursing and focuses on navigating chronic conditions, coordinating across providers, and empowering patients through education.

As part of a field-based team, you’ll build trusted relationships, support transitions of care, and help close quality gaps while

Qualifications

• Active RN license and unrestricted practice.
• Minimum of 3 years RN experience.
• Experience in community/home-based or field settings preferred.
• Experience in care management or chronic disease management preferred.
• Strong communication, organization, and relationship-building skills.
• Valid driver’s license and reliable transportation.

Responsibilities

• Conduct comprehensive nursing assessments in patients' homes and community settings.
• Partner with NPs and Medical Directors to support high- and rising-risk patients.
• Coordinate care with specialists, PCPs, hospitals, and community orgs.
• Educate patients on chronic disease management and preventive care.
• Support transitions of care after hospitalizations or ED visits.
• Identify and close care gaps via outreach and coordination.
• Document barriers and follow-up needs; reinforce care plans.
• Build long-term patient and family relationships.
• Document patient interactions using Athena, Salesforce, and other tech.

Skills

RN license

RN experience

care management

community care

communication

independent work

Tools

Athena

Salesforce

Job description

About Matter Health

Matter Health delivers primary and preventive healthcare directly to older adults living in affordable housing communities.

Our mission is simple: improve healthcare access by meeting patients where they are. Through relationship-based, value-driven care, we help older adults live healthier, more independent lives while reducing barriers to quality healthcare.

As we continue expanding across Massachusetts, we're looking for compassionate Registered Nurses who are passionate about building meaningful patient relationships and making a lasting impact in the communities they serve.

Total Healthcare. Where you live.

About the Role

The Registered Nurse (RN) Care Manager is a community-based, field role that partners closely with our Nurse Practitioners and interdisciplinary care team to deliver coordinated, relationship-focused care to older adults living in affordable housing communities.

This is not a traditional bedside nursing, home health, or private duty position. Instead, you'll serve as an extension of the primary care team-helping patients navigate chronic conditions, coordinating care across providers and community resources, supporting transitions of care, and empowering patients through education and long-term relationship building.

If you enjoy working independently, building trusted relationships, and making a meaningful difference in patients' lives, we'd love to meet you.

What You’ll Do

• Conduct comprehensive nursing assessments in patients' homes and community settings

• Partner with Nurse Practitioners and Medical Directors to support high-risk and rising-risk patients

• Coordinate care with specialists, primary care providers, hospitals, health plans, and community organizations

• Educate patients on chronic disease management, medication adherence, preventive care, and healthy lifestyle choices

• Support patients through transitions of care following hospitalizations or emergency department visits

• Help identify and close quality care gaps through patient outreach, education, and care coordination

• Reinforce care plans developed by providers while documenting barriers and follow-up needs

• Build trusted, long-term relationships with patients and their families

• Document patient interactions and care activities using Athena, Salesforce, and other technology platforms

What We’re Looking For

• Active, unrestricted Registered Nurse (RN) license

• Minimum of 3 years of RN experience

• Experience working independently in community, home-based, or field settings preferred

• Experience in care management, case management, primary care, value-based care, home health, or chronic disease management preferred

• Strong communication, organization, and relationship-building skills

• Passion for serving older adults and improving healthcare access

• Comfortable working independently while collaborating with an interdisciplinary care team

• Experience with electronic health records (EHRs) and healthcare technology

• Valid driver’s license and reliable transportation

Why Matter Health?

At Matter Health, relationships come first.

We believe healthcare should be personal, proactive, and delivered where patients feel most comfortable. Every member of our team plays an important role in improving healthcare access for older adults who have historically faced barriers to care.

This isn't just our mission—it’s what we do every day.

Total Healthcare. Where you live.

Working at Matter Health

We believe in taking care of our team just as we care for our patients. Benefits for full-time employees begin the first day of the month following your start date.

Health & Wellness

• Medical, dental, and vision insurance

• Employer-funded HSA options

• Employer-paid life and disability insurance

• Optional supplemental insurance plans

• Access to Matter Health's in-person and virtual care services

Financial Benefits

• Competitive salary

• 401(k) with company match beginning on Day 60

• Financial wellness resources

Time Away

• Up to 4 weeks of Paid Time Off

• 10 paid company holidays

• 2 paid Volunteer Days each year

Equal Opportunity Employer

Matter Health is proud to be an Equal Opportunity Employer. We celebrate diversity and are committed to creating an inclusive workplace where every team member feels valued, respected, and empowered to make a difference.