Care Manager (RN)

Provides support for care management and care coordination activities, collaborating with a multidisciplinary team to deliver integrated member care across the continuum. Ensures member progress toward desired outcomes and contributes to the strategy for quality, cost-effective care.

Responsibilities

• Completes comprehensive assessments of members per regulated timelines and determines eligibility for care management based on clinical judgment, health changes, or psychosocial wellness triggers.
• Develops and implements care coordination plans in collaboration with members, caregivers, physicians, and other healthcare professionals to address member needs and goals.
• Conducts telephonic, face-to-face, or home visits as required.
• Performs ongoing monitoring of care plans to evaluate effectiveness, document interventions, track goal achievement, and suggest adjustments.
• Maintains an ongoing member caseload for regular outreach and management.
• Promotes integration of services, including behavioral health, long-term services and supports (LTSS), and home and community resources to enhance continuity of care.
• Facilitates interdisciplinary care team (ICT) meetings and informal ICT collaboration.
• Uses motivational interviewing and clinical guideposts to educate, support, and motivate members during contacts.
• Assesses barriers to care, provides coordination, and assists members in addressing concerns.
• May provide consultation, resources, and recommendations to peers as needed.
• For Care Manager RNs: May handle complex member cases, medication regimens, and conduct medication reconciliation.
• 25-40% estimated local travel may be required (based on state or contractual requirements).

Requirements

• At least 2 years of experience in healthcare, preferably in care management, or in a medical and/or behavioral health setting, or an equivalent combination of relevant education and experience.
• Active and unrestricted Registered Nurse (RN) license in the state of practice.
• Valid and unrestricted driver’s license, reliable transportation, and adequate auto insurance for job-related travel (unless otherwise required by law).
• Understanding of electronic medical records (EMR) and Health Insurance Portability and Accountability Act (HIPAA) regulations.
• Demonstrated knowledge of community resources.
• Proactive, detail-oriented, and able to work in diverse settings while adjusting to various personalities and situations.
• Ability to work independently with minimal supervision and strong self-motivation.
• Responsiveness in all forms of communication and ability to remain calm in high-pressure situations.
• Excellent time-management, prioritization, and multitasking skills with adaptability to change.
• Strong problem-solving, critical-thinking, and both verbal and written communication skills.
• Proficiency in Microsoft Office suite and ability to navigate online portals and databases.

Preferred Qualifications

• Certified Case Manager (CCM).

Pay

$30.37 - $59.21 per hour. Actual compensation may vary based on geographic location, work experience, education, and skill level.