Title: Registered Nurse (CM/UM)
Location: Remote
Duration: 12 Months
Shift: 8am-5pm EST
Summary:
The Case Manager RN coordinates a multidisciplinary care team to deliver holistic, person-centered care for a diverse health plan population. Serving as the primary point of contact for members, caregivers, and providers, the role uses telephonic and digital channels to assess needs, develop and manage individualized care plans, and support members across the full care continuum.
Key Responsibilities
- Lead and coordinate a multidisciplinary team (social workers, dietitians, pharmacists, clinicians, and medical directors).
- Assess medical, psychosocial, cultural, and support needs of members.
- Develop, implement, monitor, and adjust individualized care plans.
- Engage members and caregivers to address barriers, gaps in care, and health goals.
- Coordinate care with providers, community resources, and support systems.
- Provide health education, self-management guidance, and care transition support.
- Advocate for members and promote self-advocacy.
- Arrange services such as community resources, mental health support, DME, and transportation.
- Document care activities accurately and meet quality and productivity standards.
- Support discharge planning and continuity of care.
- Maintain professional standards, certifications, and ongoing education.
Qualifications
- RN with Nursing Diploma or Associate’s degree required; BSN strongly preferred.
- Minimum 3 years of clinical nursing experience.
- Case management experience in managed care preferred.
- Experience delivering care telephonically and digitally preferred.
- CCM certification (required within 18 months of hire); CCP preferred.
- Strong critical thinking, communication, time management, and motivational interviewing skills.
- Proficiency with Microsoft Office tools and care management systems.
