Care Manager (RN)

Position Title: Care Manager (RN)
Work Location: Remote - FL
Assignment Duration: 6 months; potential to extend or convert
Work Schedule: Monday - Friday, 8 a.m. to 5 p.m
Work Arrangement: Remote

Position Summary:
Develops, assesses, and coordinates care management activities for members diagnosed with a variety of physical health conditions based on member needs to provide quality, cost-effective healthcare outcomes. Develops or contributes to the development of a personalized care plan/service plan for members and educates members and their families/caregivers on services and benefit options available to improve health care access and receive appropriate high-quality care through advocacy and care coordination.

Background & Context:
Business Growth of members who have a variety of physical health conditions under the MMA specialty plan. The MMA team at The Organization operates within the Care Management department, supporting a high-touch, mission-driven population of members living with chronic, complex, and/or acute physical health conditions, that may include behavioral health co-morbidities and social determinants of health needs. The team is highly focused on improving member outcomes, including medication adherence, closing HEDIS care gaps, and ensuring engagement in care. There is a case ratio of 1 staff to 75-100 members.

Key Responsibilities:

• Member Outreach & Engagement - Conduct outreach to newly assigned and existing members to complete required assessments of member needs. Maintain consistent follow-up to ensure members remain engaged in care management.
• Assessment & Care Planning - Develop individualized care plans based on clinical, behavioral, and social needs. Continuously reassess and update care plans as member needs evolve.
• Care Coordination - Connect members to primary care providers, specialists, and community resources. Facilitate scheduling, referrals, and removal of barriers to care.
• Medication & Treatment Adherence - Provide education and support to ensure compliance with treatment plan. Monitor adherence and address gaps to improve member health outcomes.
• Quality & Outcomes Management - Identify and close HEDIS care gaps to improve preventive care and chronic condition management. Focus on improving overall health outcomes.

Qualification & Experience:

Candidate Requirements Education/Certification Required: Requires a Bachelor's degree and 2 - 4 years of related experience. Requirement is Graduate from an Accredited School of Nursing if holding clinical licensure .
Or equivalent experience acquired through accomplishments of applicable knowledge, duties, scope and skill reflective of the level of this position. Preferred: RN with case management & managed care experience with relevant clinical experience Licensure Required: RN Preferred: Care Management background experience included with previous clinical experience is a PLUS Years of experience required: 2-4 or more years of experience working in case management and/or managed care.

Disqualifiers:

Additional qualities to look for: Good communication skills, history in care management work, able to discuss a broad spectrum of physical health conditions

• Top 3 must-have hard skills stack-ranked by importance

1 Fast learner with strong documentation skills and the ability to quickly navigate and adapt to multiple systems. Proficient in Microsoft applications and comfortable working in a technology-driven environment. Experienced in managing a full telephonic workload, including extended headset use, while accurately tracking and documenting activities such as breaks, lunches, meetings, and trainings within phone-based systems. 2 Strong communication and engagement skills, with the ability to build rapport, educate members, and effectively guide conversations to support care plan adherence and improved health outcomes.
3 Good time management skills
4 Ability to navigate well through systems 5 Proficient in Microsoft Office Suites Position is offered by a no fee agency.