Remote Complex Case Manager (RN) — Care Coordination

MagnaCare; Chapel Hill (NC); Remote; USD 80,000 - 110,000; Full time

Benefits offered by this job

Remote role

Job summary

MagnaCare is seeking a Complex Case Manager to oversee a caseload of members with complex medical and care coordination needs. You will report to the Supervisor, Case Management and work with an interdisciplinary team to develop member-centered care plans.

You will conduct comprehensive assessments, coordinate care across the continuum, educate members and caregivers, maintain timely documentation, and ensure compliance with NCQA, HIPAA, and applicable regulations.

Qualifications

• Active, unrestricted RN license.
• Compact license required; NYS licensure preferred and ability to obtain NYS license within 30 days of hire.
• 2+ years of nursing experience in care management, population health, or related clinical setting.
• Knowledge of NCQA Care Management standards, HIPAA, and regulatory requirements.
• Strong communication and ability to work independently.
• Experience with complex/ chronic condition management.

Responsibilities

• Conduct comprehensive assessments to identify complex medical, psychosocial, functional, utilization, and care coordination needs.
• Develop, implement, monitor, and update individualized, member-centered care plans in collaboration with members, caregivers, providers, and interdisciplinary teams.
• Coordinate care across the healthcare continuum to promote quality outcomes, appropriate utilization, member engagement, and cost-effective care.
• Provide education and coaching to members and caregivers regarding health conditions, treatment plans, medications, preventive care, and self-management strategies.
• Identify and address barriers to care, treatment adherence, health equity, and achievement of care plan goals.
• Facilitate transitions of care and support timely access to medical and community-based services.
• Maintain accurate documentation of assessments, care plans, interventions, and member progress in EMR in compliance with standards.
• Collaborate with Utilization Management, Population Health, Medical Directors, and other stakeholders to support integrated care delivery.
• Participate in quality improvement initiatives and accreditation activities.
• Perform other duties as assigned.

Skills

RN license

Care coordination

Clinical assessment

Communication skills

Education

BSN preferred

ADN acceptable with experience

Tools

EMR systems

Microsoft Office

Job description

MagnaCare is seeking a Complex Case Manager to oversee a caseload of members with complex medical and care coordination needs. You will report to the Supervisor, Case Management and work with an interdisciplinary team to develop member-centered care plans.

You will conduct comprehensive assessments, coordinate care across the continuum, educate members and caregivers, maintain timely documentation, and ensure compliance with NCQA, HIPAA, and applicable regulations.