RN Care Manager

30030 Health Services for Children with Special Needs, Inc.; United States; Hybrid; USD 77,584 - 129,292; Full time

Job summary

30030 Health Services for Children with Special Needs, Inc. is looking for an RN Care Manager to provide comprehensive care coordination for enrollees with high-complexity medical needs. The role involves managing a caseload, conducting assessments, and ensuring compliance with care management requirements.

The ideal candidate should have a nursing degree and relevant experience in care management, with strong communication skills and proficiency in Microsoft Office. This is a hybrid role, requiring both field engagement and office work.

Qualifications

• 2 years clinically related experience in Care Management or Managed Care required.
• Experience in a public/community health setting required.
• Registered Nurse, DC License required upon hire.

Responsibilities

• Manage a caseload of medically fragile enrollees for care coordination.
• Assess enrollees' needs and develop comprehensive care plans.
• Conduct home visits as necessary based on enrollee acuity.

Skills

Advanced knowledge of clinical standards of care and disease processes

Excellent verbal and written communication skills

Excellent customer service skills

Proficient in Microsoft Office applications

Education

Associate’s Degree in Nursing (Required)

Bachelor’s Degree in Nursing (Preferred)

Tools

Microsoft Word

Microsoft Excel

Microsoft PowerPoint

Job description

Kids Are Our Everything.

Department 10514 HSCSN – Care Management

Pay Range: $77,584.00 – $129,292.80

Position Overview

Under the direction of the Supervisory Care Manager, the RN Care Manager (CM) is responsible for providing comprehensive care coordination services to enrollees with high‑complexity medical and behavioral needs who are enrolled in the Health Services for Children with Special Needs (HSCSN) health plan. The CM will have a caseload of medically fragile enrollees focusing on medical intervention and associated care coordination needs outlined by the enrollee assigned acuity level. The CM routinely communicates with enrollees on their assigned caseload to assess their needs; develop, monitor, and evaluate treatment plan progress; and assist with coordinating care and referring to appropriate services for enrollees with highly complex medical and psychosocial needs.

Minimum Education

• Associate’s Degree in Nursing (Required) or Bachelor’s Degree in Nursing (Preferred)

Minimum Work Experience

• 2 years clinically related experience working in Care Management, Discharge Coordination, Home Health, Utilization Review, Disease Management, or Managed Care (Required)
• 1 year working in a public/community health setting (Required)

Required Skills & Knowledge

• Advanced knowledge of clinical standards of care and disease processes.
• Excellent verbal and written communication skills, and telephonic and keyboarding skills necessary to assess, coordinate, and document services.
• Spanish speaking preferred.
• Excellent customer service skills both internal and external.
• Proficient in knowledge of available community resources and programs.
• Proficient in the use of web‑based technology and Microsoft Office applications such as Word, Excel, and PowerPoint.
• Ability to produce accurate and comprehensive work products with minimal direction.
• Ability to meet established deadlines and handle multiple customer service demands within set expectations for service excellence.
• Basic understanding of strategic and financial goals of a health care system or payor organization, and healthcare operations (networks, eligibility, benefits).
• Ability to work effectively in a fast‑paced environment with frequently changing priorities, deadlines, and workloads.

Required Licenses and Certifications

• Registered Nurse, DC License (Upon Hire, Required)
• Certified Case Manager (CCM) – 1 Year (Preferred)

Essential Job Duties

• Manages a caseload as outlined by CASSIP and Care Management Leadership.
• Maintains compliance in accordance with contractual and care management requirements.
• Assists in research and implementation of disease management/population health programs for highest complexity members.
• Conducts outreach and face‑to‑face visits at least as frequently as determined by the enrollee’s acuity level; visits enrollees and their caregivers in homes, physician’s offices, or other mutually agreed upon locations.
• Assesses enrollees on enrollment and at intervals as determined by the enrollee’s acuity level to identify needs/barriers and close gaps in care.
• Identifies over/under utilization promptly and takes appropriate action according to organizational policy.
• Gathers physical and mental/behavioral health, environmental, psychosocial, and educational information; develops, implements, and updates individualized comprehensive care plans in collaboration with PCPs and other multidisciplinary team members, including public agencies.
• Completes routine care coordination and care management activities with attention to quality, timeliness, and compliance with company policy and NCQA standards.
• Consults with Supervisory Care Manager to review and prioritize cases, set objectives, identify and report potential risk and utilization concerns.
• Accurately and timely documents enrollee findings and interactions according to organizational policy.
• Abides by HSCSN’s confidentiality policy and procedure regarding enrollee specific information.
• Participates in disposition and discharge planning activities; contributes to the discharge plan in a timely manner, considering enrollee/family/significant others and matching to healthcare resources.
• Communicates verbally and in writing clearly and respectfully.
• Assists/empowers caregivers or enrollees to participate in childcare/self‑management.
• Assists assigned enrollees and caregivers in understanding the importance of EPSDT and compliance with all health services.
• Works toward target compliance rates for preventive medical and dental services.
• Assists with scheduling and monitors compliance of mental health/medical appointments.
• Follows department policies for identifying and reporting non‑compliance, missed appointments, and other reportable incidents.
• Applies advanced knowledge of target population conditions and standard care management approaches.
• Attends multidisciplinary meetings as necessary, including off‑site meetings with other agencies.
• Receives and reviews vendor or contracted provider visit reports, and facilitates coordination of follow‑up care.
• Refs enrollee/caregiver to appropriate vendors for DME/assistive technology use.
• Educates on medication administration, conditions, and self‑management techniques.
• Assists in planning transitions of care (e.g., Early Intervention to DCPS, pediatric to adult providers, discharge from HSCSN, transitions between outpatient/inpatient, and custody changes).
• Enter authorizations for services requiring authorization by Care Management staff.
• Performs ongoing monitoring of the care plan to evaluate effectiveness, document interventions and goal achievement, and update accordingly.
• Uses communication skills that promote understanding and collaboration with enrollees, families, HSCSN staff, providers and others.
• Positively presents accurate information about HSCSN to all stakeholders.

Additional Responsibilities

• May perform other duties in addition to those outlined.

This is a hybrid role, with time spent in the field engaging enrollees in the community.

Equal Opportunity Employment

Children’s National Hospital is an equal opportunity employer that evaluates qualified applicants without regard to race, color, national origin, religion, sex, age, marital status, disability, veteran status, sexual orientation, gender identity or other characteristics protected by law.