RN Care Manager - Full Time

About the role

The Care Manager is responsible for conducting comprehensive assessments to determine appropriate services and benefits based on medical necessity. They provide plan education, coordinate healthcare services, advocate for enrollees, and ensure timely, cost-effective, and quality care delivery.

Responsibilities

• Identify and coordinate enrollee services, including non-benefit services like Medicare.
• Complete assessments with approved tools to evaluate eligibility for necessary services.
• Educate enrollees, obtain consents, and document interactions.
• Monitor physical, emotional, social, cultural, economic, and environmental needs, adjusting plans accordingly.
• Observe changes in condition, facilitate appropriate follow-up, and develop individualized care plans with measurable goals.
• Implement medical orders, maintain documentation in electronic records, and manage DME and treatments.
• Participate in team activities, mentor staff, and ensure compliance with regulations such as HIPAA.
• Manage conflicts, prioritize tasks, and make independent decisions within scope of practice.

Qualifications

• Licensed registered nurse or BSN with current registration in the relevant state.
• Strong communication, organizational, and time management skills.
• Experience working with diverse patient populations across various settings.
• Valid driver’s license, personal vehicle, and BLS certification.

Computer literacy and 1–2 years of community-based healthcare experience are preferred.