CareMore Care Manager (US)

Key Responsibilities

• Assess, plan, facilitate, coordinate, monitor, and evaluate services to meet the healthcare needs of members, particularly those with complex or high-risk conditions.
• Develop and implement comprehensive clinical case management plans tailored to each patient’s medical, behavioral, and social needs.
• Collaborate with physicians, advanced practice providers, and interdisciplinary care teams to support evidence-based care and effective disease management.
• Monitor patient progress and revise care plans as needed to address changes in clinical status or care needs.
• Identify and address barriers to care including social determinants of health, treatment adherence challenges, or gaps in services.
• Analyze patient variances from the established care plan and initiate appropriate interventions to resolve issues and improve outcomes.
• Support CareMore’s value-based care model by focusing on improved outcomes, care coordination, and appropriate utilization of healthcare services.
• Manage high-risk or medically complex patients with chronic conditions such as heart failure, diabetes, COPD, and other conditions requiring ongoing care coordination.
• Collaborate with care teams to proactively manage patients who are at risk for hospitalization or complications.
• Promote preventive care, chronic disease management, and patient engagement strategies that improve long-term health outcomes.
• Support members and their representatives regarding care needs, care transitions, and changes in health status.
• Serve as a liaison between patients, providers, and care teams to facilitate coordinated care delivery.
• Coordinate services across multiple care settings including primary care, specialty care, hospitals, skilled nursing facilities, home health agencies, and community-based resources.
• Provide education and support to patients and families regarding treatment plans, medications, and self-management strategies.
• Support smooth transitions between care settings to reduce complications, readmissions, and unnecessary healthcare utilization.

Qualifications

• Current, unrestricted Registered Nurse (RN) license in the applicable state(s).
• Minimum 2 years of clinical experience in nursing, case management, care coordination, or utilization review.
• Experience working with complex, chronically ill, or high-risk patient populations preferred.
• Knowledge of care coordination, discharge planning, utilization management, and population health strategies.
• Strong clinical assessment, communication, and organizational skills.
• Satisfactory completion of required health screenings including TB testing (must be within the last 12 months).
• Hep B vaccinations (all 3, titer or signed declination).