RN Care Manager

Jobtailor; Boston (MA); On-site; USD 85,000 - 115,000; Full time

Job summary

Jobtailor is seeking a Registered Nurse to engage enrollees in their homes and community settings, coordinating care with providers and resources. You will lead an interdisciplinary team to develop holistic care plans and support transitions between care settings.

The role emphasizes complex care management, utilization oversight, and education of beneficiaries on Medicare and Medicaid benefits, with a focus on culturally competent, patient-centered care.

Qualifications

• Associates of Science 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. requested.
• 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.

Responsibilities

• Engage with enrollees in their homes and community settings to establish an effective, complex care management relationship.
• Serve as liaison between healthcare providers, community resources, and enrollees to ensure seamless communication and care transitions.
• Perform required assessments (Comprehensive, MDS-HC Functional Assessments, Crisis and Risk Assessments) in a timely manner.
• Engage enrollees in care plan development and implementation with routine updates.
• Lead the interdisciplinary care team (ICT) to create holistic care plans addressing medical and non-medical needs.
• Oversee enrollee utilization of long-term services and supports to enable staying in chosen location.
• Assist members in accessing community resources (housing, transportation, food, social services).
• Educate members about benefits and services under Medicare and Medicaid.

Skills

Care Coordination

Case Management

Team Collaboration

Cultural Competence

Effective Communication

Advocacy

Medicaid Experience

Medicare Experience

Education

Associate of Science in Nursing

Tools

MDS-HC Assessment

Job description

• 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

• 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

Core Competencies

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 Nurse
• Care Coordination
• Case Management
• Medicaid Experience
• Medicare Experience

ATS Optimization Keywords

Hard Skills

• Comprehensive Assessment
• MDS-HC Functional Assessment
• Crisis Assessment
• Risk Assessment
• Chronic Condition Management
• Preventive Care Strategies
• Gap Closure Strategies
• Community Resource Access
• Health Education
• Utilization Management

Soft Skills

• Effective Communication
• Advocacy
• Interpersonal Skills
• Team Collaboration
• Cultural Competence

Certifications & Qualifications

• Associates of Science (A.S) in Nursing

Industry Keywords

• Dual-Eligible Populations
• Long-Term Services and Supports
• NCQA Standards
• Care Management Standards
• Community-Based Organizations