Care Manager, Adult Services - RN

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Job Description:

The Care Manager (RN) is responsible for delivering clinically and psychosocially informed, person-centered care management services to Medicaid members with complex physical, behavioral health, and social determinants of health.

This role conducts comprehensive clinical and/or biopsychosocial assessments, manages Transitions of Care (TOC) and other high-risk outreach, develops individualized care plans, and supports members through care coordination, system navigation, and condition management.

The Care Manager is a licensed professional who collaborates with interdisciplinary and multi-agency teams to ensure coordinated, high-quality care that improves member engagement, stability, health outcomes, and reduces avoidable utilization.

This role requires comfort with outbound outreach, including cold-call engagement of hard-to-reach members, to meet program productivity standards and contractual performance requirements.

ESSENTIAL DUTIES:

• Perform comprehensive clinical and/or psychosocial assessments for assigned high-risk, medically complex, and high-barrier members .


• Develop, implement, and update individualized care plans addressing medical, behavioral health, psychosocial, and environmental needs.


• Manage transitions of care following hospitalization, emergency department utilization, facility stays, behavioral health transitions, or other acute episodes.


• Complete all required follow-up for transition-of-care and assigned populations within established timelines.


• Conduct ongoing care management, monitoring, and coordination for designated members .


• Identify and address barriers affecting adherence, recovery, stabilization, and follow-up, including housing, transportation, food insecurity, caregiver support, financial strain, behavioral health, and substance use concerns.


• Coordinate care with PCPs, specialists, behavioral health providers, facilities, caregivers, interdisciplinary teams, and community agencies.


• Connect patients to community resources, social services, behavioral health resources, and support programs.


• Provide patient and caregiver education related to disease management, self-management, care navigation, resource access, and next steps in care.


• Utilize motivational interviewing, engagement strategies, and de-escalation techniques to support member participation and goal attainment.


• Escalate urgent clinical, psychosocial, crisis, safety, or member-protection concerns appropriately.


• Collaborate with interdisciplinary teams to support integrated, person-centered care delivery.


• Maintain timely, accurate, and compliant documentation across assessments, care plans, outreach, follow-up, and coordination activities.


• Maintains a high level of confidentiality and ensures compliance with HIPAA regulations


• Assist with planning, coordinating, and representing the organization at community events designed to retain existing members and generate awareness among prospective members.


• Deliver educational presentations to existing and prospective members at community events, clinics, and partner sites: evening and weekend availability is required to support scheduled events and community programming.


• Other duties as assigned

POPULATION SERVED:

• Medicaid and designated high-risk, complex member populations


• Member requiring transition-of-care support


• Member with repeated utilization, worsening acuity, or chronic-condition instability


• Member with psychosocial, behavioral health, environmental, or social determinants of health barriers


• Member requiring community-resource linkage and psychosocial intervention


• Other assigned populations as applicable

EDUCATION:

Active unrestricted Registered Nurse (RN) license in good standing.

Must be licensed in the state where the assigned population is served.

EXPERIENCE:

1+ years of experience in care management, care coordination, case management, behavioral health, social work, utilization management, transitional care, or related experience.

Experience working with high-risk, medically complex, behavioral health, or psychosocially complex populations.

Experience supporting transitions of care.

Preferred experience:

• Experience with Medicare Advantage, Medicaid, DSNP, and/or CSNP populations.


• Experience in value-based care, managed care, or population health.


• Case management certification or related credential.


• Bilingual capability, where relevant to market needs

KNOWLEDGE, SKILLS, ABILITIES:

• Knowledge of community resources and behavioral health supports.


• Proficiency with EMR and care-management documentation systems.


• Complete assessments, care plans, outreach, and follow-up activities within required timelines.


• Complete transition-of-care follow-up within organizationally defined timeframes.


• Maintain timely and compliant documentation across all care management activities.


• Meet expectations related to care-plan completion, case progression, barrier resolution, and member engagement.


• Escalate urgent or deteriorating clinical, psychosocial, or safety concerns promptly.


• Meet role-specific LPIs/productivity expectations and delegated responsibilities.


• Strong clinical and/or psychosocial assessment and intervention skills


• Strong care planning and coordination capability


• Knowledge of behavioral health, community-resource systems, and social determinants of health


• Strong crisis support and de-escalation ability


• Ability to manage medically complex and high-barrier patients across settings


• Strong communication and collaboration with providers, caregivers, and interdisciplinary teams


• Motivational interviewing and patient engagement skills


• Strong documentation, follow-through, and compliance discipline


• Ability to prioritize risk and intervene appropriately


• Ability to manage sensitive and complex cases professionally


• Home office, that is HIPAA compliant for all remote or telecommuting positions as outlined by the company policies and procedures

Salary Range:

$63,502.40- $90,719.20

Additional Compensation:

Eligible for annual bonus based on individual and/or company performance.

Benefits:

Includes medical, dental, and vision insurance; 401(k); paid time off (PTO); and Employee Assistance Program (EAP)

Application Deadline:

Open until filled. Applications will be reviewed on a rolling basis.