Complex Care Manager RN - Tidewater VA Markets

About the Role

The Complex Care Manager, RN manages high-risk members to promote their independence and self-sufficiency. This role conducts assessments, develops and revises care plans, and coordinates services in community or home settings, focusing on disease management and health maintenance. It involves telephonic and face-to-face engagement, advocating for members, collaborating with healthcare providers, and ensuring proper documentation.

Responsibilities

• Engage members and families to coordinate services and treatment needs
• Deliver holistic, person-centered care based on individual needs
• Identify early risk factors and conduct ongoing health assessments
• Develop, review, and update comprehensive care plans
• Act as an advocate for members and coordinate with PCPs and community resources
• Build relationships and assist members with health decisions
• Ensure timely documentation and coordinate with state agencies and providers
• Serve as the primary contact for members and care teams

Qualifications & Skills

• Unrestricted RN license in Virginia
• 2+ years in case management, home or long-term care, or related settings
• 1+ years working with individuals with complex medical or behavioral needs
• Proficiency in Microsoft Office and reliable internet
• Ability to travel within Virginia and access to transportation

Preferred Qualifications

• CCM certification
• Experience with Medicare/Medicaid and managed care
• Experience with complex populations