Case Management Nurse - 251922

Medix™; Washington (District of Columbia); Hybrid; USD 85,000 - 110,000; Full time

Job summary

A leading health plan organization is seeking a passionate RN to manage complex cases and advocate for high-acuity patients. In this role, you will coordinate care, conduct telephonic assessments, and develop individualized care plans. The ideal candidate holds an active DC RN License and has over 2 years of nursing experience with case management expertise. The position offers a hybrid work model, providing a meaningful opportunity to elevate your nursing career while making a real impact on patient outcomes.

Qualifications

• Required DC RN License must be obtained upon hire.
• Two or more years of nursing experience in a clinical setting.
• Experience in case management, especially with high-acuity patients.
• Experience with high-acuity or frequently hospitalized patients.
• Familiarity with NCQA standards and guidelines.
• Hybrid work: 4 days onsite, 1 day remote.

Responsibilities

• Manage a caseload of up to 45 members continuously.
• Conduct telephonic assessments and follow up with patients post-discharge.
• Develop and implement individualized care plans based on patient needs.
• Document per NCQA standards in audit-ready format.
• Develop and execute individualized care plans.
• Lead complex case management for high-risk populations.
• Coordinate care across medical, behavioral, and social services.
• Advocate for access to essential healthcare resources.
• Collaborate with hospital teams on discharge planning.
• Identify service gaps and implement solutions.
• Monitor utilization, quality, and compliance (fraud, waste, abuse).
• Participate in interdisciplinary meetings and community outreach.

Skills

Telephonic clinical assessments

High-acuity patient management

Patient advocacy

Care coordination

Quality compliance (NCQA standards)

Education

Active DC RN License

2+ years of nursing experience

1-2 years of case management experience

Job description

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.