RN Care Manager: Chronic Care & Transitions Leader

Selectminds; Clarkston (MI); On-site; USD 70,000 - 90,000; Full time

Job summary

McLaren Health Care is seeking a Registered Nurse Care Manager for Clarkston Medical Group to partner with primary care teams in managing chronic and high-risk patients. Responsibilities include comprehensive nursing assessments, care coordination, and ongoing patient education to improve outcomes.

The role emphasizes safe transitions of care, telephonic or in-person engagement based on patient needs, and collaboration with interdisciplinary teams to close gaps in care.

Qualifications

• Current unrestricted Registered Nurse license in the State of Michigan.
• Graduate of an accredited school of nursing.
• Minimum of two years of clinical nursing experience preferred, particularly in primary care, ambulatory care, chronic disease management, care coordination, population health, home health, case management, or a related setting.
• Current BLS certification as required by organizational policy.
• Experience caring for patients with chronic and complex medical conditions strongly preferred.
• Previous care-management, case-management, population-health, or transitional-care experience preferred.

Responsibilities

• Identify, enroll, and manage patients for PDCM, chronic care management, transitional care management, and other care-management services.
• Perform comprehensive nursing assessments to identify clinical needs, barriers to care, health literacy needs, psychosocial concerns, medication issues, and health care utilization patterns.
• Collaborate with patient and care team to develop and monitor an individualized care plan.
• Establish goals with patients and caregivers and provide ongoing coaching and follow-up.
• Serve as a primary contact for patients in care management and communicate changes to providers.

Skills

Clinical nursing experience

Care coordination

Chronic disease management

Home health

Education

Graduated from an accredited school of nursing

RN license in Michigan (unrestricted)

Current BLS certification

Job description

McLaren Health Care is seeking a Registered Nurse Care Manager for Clarkston Medical Group to partner with primary care teams in managing chronic and high-risk patients. Responsibilities include comprehensive nursing assessments, care coordination, and ongoing patient education to improve outcomes.

The role emphasizes safe transitions of care, telephonic or in-person engagement based on patient needs, and collaboration with interdisciplinary teams to close gaps in care.