Care Manager, Adult Services - RN

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About the role

The Care Manager (RN) delivers clinically and psychosocially informed, person-centered care management services to Medicaid members with complex physical, behavioral health, and social determinants of health. This role conducts comprehensive assessments, manages Transitions of Care (TOC) and high-risk outreach, develops individualized care plans, and supports members through care coordination, system navigation, and condition management. The Care Manager collaborates with interdisciplinary and multi-agency teams to ensure coordinated, high-quality care that improves member engagement, stability, health outcomes, and reduces avoidable utilization. Comfort with outbound outreach, including cold-call engagement of hard-to-reach members, is required to meet program productivity standards and contractual performance requirements.

Responsibilities

• Perform comprehensive clinical and/or psychosocial assessments for assigned high-risk, medically complex, and high-barrier members.
• Develop, implement, and update individualized care plans addressing medical, behavioral health, psychosocial, and environmental needs.
• Manage transitions of care following hospitalization, emergency department utilization, facility stays, behavioral health transitions, or other acute episodes.
• Complete all required follow-up for transition-of-care and assigned populations within established timelines.
• Conduct ongoing care management, monitoring, and coordination for designated members.
• Identify and address barriers affecting adherence, recovery, stabilization, and follow-up, including housing, transportation, food insecurity, caregiver support, financial strain, behavioral health, and substance use concerns.
• Coordinate care with PCPs, specialists, behavioral health providers, facilities, caregivers, interdisciplinary teams, and community agencies.
• Connect patients to community resources, social services, behavioral health resources, and support programs.
• Provide patient and caregiver education related to disease management, self-management, care navigation, resource access, and next steps in care.
• Utilize motivational interviewing, engagement strategies, and de-escalation techniques to support member participation and goal attainment.
• Escalate urgent clinical, psychosocial, crisis, safety, or member-protection concerns appropriately.
• Collaborate with interdisciplinary teams to support integrated, person-centered care delivery.
• Maintain timely, accurate, and compliant documentation across assessments, care plans, outreach, follow-up, and coordination activities.
• Maintain a high level of confidentiality and ensure compliance with HIPAA regulations.
• Assist with planning, coordinating, and representing the organization at community events designed to retain existing members and generate awareness among prospective members.
• Deliver educational presentations to existing and prospective members at community events, clinics, and partner sites; evening and weekend availability is required.
• Other duties as assigned.

Population Served

• Medicaid and designated high-risk, complex member populations.
• Members requiring transition-of-care support.
• Members with repeated utilization, worsening acuity, or chronic-condition instability.
• Members with psychosocial, behavioral health, environmental, or social determinants of health barriers.
• Members requiring community-resource linkage and psychosocial intervention.
• Other assigned populations as applicable.

Requirements

• Active unrestricted Registered Nurse (RN) license in good standing; must be licensed in the state where the assigned population is served.
• 1+ years of experience in care management, care coordination, case management, behavioral health, social work, utilization management, transitional care, or related experience.
• Experience working with high-risk, medically complex, behavioral health, or psychosocially complex populations.
• Experience supporting transitions of care.

Preferred Qualifications

• Experience with Medicare Advantage, Medicaid, DSNP, and/or CSNP populations.
• Experience in value-based care, managed care, or population health.
• Case management certification or related credential.
• Bilingual capability, where relevant to market needs.

Skills

• Knowledge of community resources and behavioral health supports.
• Proficiency with EMR and care-management documentation systems.
• Strong clinical and/or psychosocial assessment and intervention skills.
• Strong care planning and coordination capability.
• Knowledge of behavioral health, community-resource systems, and social determinants of health.
• Strong crisis support and de-escalation ability.
• Ability to manage medically complex and high-barrier patients across settings.
• Strong communication and collaboration with providers, caregivers, and interdisciplinary teams.
• Motivational interviewing and patient engagement skills.
• Strong documentation, follow-through, and compliance discipline.
• Ability to prioritize risk and intervene appropriately.
• Ability to manage sensitive and complex cases professionally.

Home office must be HIPAA compliant for all remote or telecommuting positions as outlined by company policies and procedures.

Pay

Salary Range: $63,502.40 - $90,719.20

Additional compensation: Eligible for annual bonus based on individual and/or company performance.

Benefits

• Medical, dental, and vision insurance.
• 401(k).
• Paid time off (PTO).
• Employee Assistance Program (EAP).