Case Management Nurse - 251922

Are you a passionate RN looking to make a meaningful impact with high-acuity patients? Join a leading health plan team where you’ll manage complex cases, advocate for vulnerable populations, and work within nationally recognized quality standards.

Overview of the Role

In this role, you will manage a complex population of patients with chronic conditions such as Diabetes, Hypertension, and COPD . You’ll play a critical role in improving outcomes through ongoing engagement, care coordination, and clinical oversight.

What You’ll Do:

• Manage a caseload of up to 45 members
• Conduct telephonic clinical assessments and follow-ups post-discharge
• Maintain bi-weekly patient touchpoints
• Perform detailed, audit-ready documentation aligned with NCQA standards
• Develop and execute individualized care plans
• Lead complex case management for high-risk populations
• Coordinate care across medical, behavioral, and social services
• Act as a patient advocate to ensure access to essential healthcare resources
• Collaborate with hospital teams on discharge planning and transitions of care
• Identify gaps in services and implement solutions
• Monitor utilization, quality, and compliance (including fraud, waste, and abuse)
• Participate in interdisciplinary meetings, quality initiatives, and community outreach
• Maintain accurate and timely documentation in clinical systems

✅ Required Qualifications

• Active DC RN License (required upon hire)
• Minimum 2+ years of nursing experience
• 1–2 years of case management experience
• Experience working with high-acuity or frequently hospitalized patients
• Familiarity with NCQA standards and guidelines
• Monday–Friday, 8:00 AM – 5:00 PM
• Hybrid: 4 days onsite, 1 day remote

This is more than a case management role—you’ll serve as a true advocate , helping patients overcome barriers and navigate complex healthcare systems while delivering measurable outcomes through meaningful engagement.

If you're ready to elevate your nursing career and make a real impact, apply today or message me directly to learn more.