- Engage with the enrollee in their homes and other community settings to establish an effective, complex care management relationship
- 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
- Lead the interdisciplinary care team (ICT) and collaborate with peers both internal and external to the organization
- Oversee enrollee utilization of long‑term services and supports
- 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
- Follow up with members after hospitalizations or significant health events
- Work closely with primary care physicians, specialists, and other healthcare providers
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
- Intermediate proficiency level with Microsoft Office, including Outlook, Word and Excel.
- Understanding of Medicare and Medicaid programs, as well community resources and services available to dual‑eligible beneficiaries.
- Strong interpersonal and communication skills to effectively engage with members, families, and healthcare providers
- Strong customer service skills
- Must have valid driver's license, vehicle and verifiable insurance.
Core Competencies
Demonstrates expertise in care coordination and case management for dual‑eligible populations, with a strong understanding of Medicare and Medicaid programs. Capable of leading interdisciplinary teams and effectively engaging with enrollees to facilitate access to community resources and services.
Highest-signal resume keywords
- Registered Nurse
- Care Coordination
- Medicaid Experience
- Medicare Experience
- Interpersonal Communication
ATS Optimization Keywords
Hard Skills
- Care Management
- Comprehensive Assessment
- MDS-HC Functional Assessment
- Crisis Assessment
- Risk Assessment
Soft Skills
- Strong Customer Service
- Effective Engagement
- Interpersonal Skills
Certifications & Qualifications
- Associates of Science in Nursing
Industry Keywords
- Dual‑Eligible Populations
- Community Resources
- Long‑Term Services and Supports
- Healthcare Providers
- Interdisciplinary Care Team
Tools & Technologies
- Microsoft Office
- Outlook
- Word
- Excel