Bilingual RN Case Manager: Chronic Care & Transitions

Medix™; Tucson (AZ); Hybrid; USD 70,000 - 90,000; Full time

Job summary

Medix seeks a fully bilingual English/Spanish RN Case Manager to support high-risk patients through chronic care management, transitions of care, and coordinated care planning. This is a direct-hire, hybrid role based in Tucson, with 2–3 days onsite and remaining days remote.

Monday–Friday, 8:00 AM–5:00 PM, with on-site days yet to be finalized. Experience in case management, transitions of care, discharge planning, utilization management, or managed care is preferred, along with strong

Qualifications

• BSN required for licensure and clinical practice.
• Fully bilingual in English and Spanish is REQUIRED.
• Professional communication in both English and Spanish; basic Spanish alone is not sufficient.
• Minimum 2 years of RN experience.
• At least 2 years in one or more: Case Management, Transitions of Care, Chronic Care Management, Utilization/Managed Care.
• Knowledge of pre-acute and post-acute care settings and resources.
• Strong communication, organization, clinical assessment, and care coordination skills.

Responsibilities

• Oversee chronic care management and transitions of care for high-risk patients.
• Serve as clinical resource to multidisciplinary teams.
• Conduct comprehensive assessments addressing physical, mental, and social risk factors.
• Develop and coordinate individualized care plans based on patient needs.
• Perform telephone triage and address or escalate patient concerns.
• Coordinate patient transitions from acute/post-acute to home or other facilities.
• Collaborate with physicians, nursing staff, and other care team members to remove barriers to care.
• Monitor patient progress and ensure plans remain patient-centered and cost-effective.
• Coordinate diagnostic testing, discharge plans, and plan of care modifications.
• Ensure understanding of discharge instructions and follow-up needs.
• Coordinate post-discharge services including home health, hospice, DME, meds, and supplies.
• Schedule PCP or specialist follow-up within 7 days of discharge.
• Reconcile discharge meds and collaborate for medication review.
• Identify eligible patients for home health and other services.
• Obtain medical records from acute facilities and track readmissions.
• Participate in performance improvement initiatives and readmission reduction programs.
• Document activities accurately in the EMR and maintain coordination records.
• Apply Coleman Model transition-of-care principles.

Skills

Bilingual in English/Spanish

Excellent communication

Care coordination

Clinical assessment

EMR documentation

Problem-solving

Education

BSN (Bachelor’s degree in Nursing)

Tools

EMR

Job description

Medix seeks a fully bilingual English/Spanish RN Case Manager to support high-risk patients through chronic care management, transitions of care, and coordinated care planning. This is a direct-hire, hybrid role based in Tucson, with 2–3 days onsite and remaining days remote.

Monday–Friday, 8:00 AM–5:00 PM, with on-site days yet to be finalized. Experience in case management, transitions of care, discharge planning, utilization management, or managed care is preferred, along with strong