Ambulatory Care Manager (RN) — Care Coordination Leader

Cape Cod Healthcare Inc; Hyannis (MA); On-site; USD 70,000 - 90,000; Full time

Benefits offered by this job

Health insurance

Retirement plan

Job summary

Cape Cod Healthcare Inc. is seeking an Ambulatory Case Manager in Massachusetts (Hyannis). You will manage PHO-covered lives to reduce acute care episodes by coordinating care with PHO physicians and an interdisciplinary team.

Responsibilities include assessment, care planning, and education, with emphasis on safe, patient-centered, cost-effective care under established guidelines. Requires RN license and related experience in hospital or outpatient settings.

Qualifications

• Must hold a Current RN license in Massachusetts.
• BSN preferred; Case Management certification preferred.
• Minimum 3 years of hospital, home health, or outpatient nursing experience.
• Ability to coordinate care and educate patients across settings.

Responsibilities

• Lead and coordinate care plans to reduce acute care episodes.
• Review referrals and implement individualized, evidence-based care plans.
• Collaborate with PCPs, specialists, and interdisciplinary teams.
• Document care plans and ensure timely communication with providers and families.
• Assess home environment and patient education needs, using guidelines.

Skills

Organization

Time management

Interpersonal skills

Communication

Critical thinking

Independent work

Problem solving

Team collaboration

Education

RN license

BSN preferred

Case management certification preferred

Tools

EHR systems

Computer proficiency

Job description

Cape Cod Healthcare Inc. is seeking an Ambulatory Case Manager in Massachusetts (Hyannis). You will manage PHO-covered lives to reduce acute care episodes by coordinating care with PHO physicians and an interdisciplinary team.

Responsibilities include assessment, care planning, and education, with emphasis on safe, patient-centered, cost-effective care under established guidelines. Requires RN license and related experience in hospital or outpatient settings.