RN Care Manager: Integrated Chronic & Behavioral Health

Cityblock Health; Fayetteville (NC); On-site; USD 90,000 - 95,000; Full time

Benefits offered by this job

Health insurance

Retirement benefits

Equity program

Paid time off

Vacation and sick leave

Job summary

Cityblock Health, located in Fayetteville, NC, seeks a Registered Nurse Case Manager (RNCM) to oversee a panel of members with chronic conditions and support integrated medical and behavioral health care through collaborative care planning.

You will assess, plan, and coordinate care with a multidisciplinary team and Community Health Partner to address social needs and ensure high-quality care inside the program guidelines.

Qualifications

• Active, unrestricted RN license in the state of employment.
• 3+ years of clinical services experience with adults and/or geriatrics with co-occurring chronic medical and behavioral health conditions.
• Willingness to travel within the community for home-based visits.

Responsibilities

• Receive members from the engagement and care team and communicate program expectations and goals.
• Perform screening tools (PHQ-9, GAD-7, AUDIT, DAST-10) to identify behavioral health needs.
• Conduct in-person clinical exams and collaborate on member placement in programs of varying intensity.
• Prepare for and participate in case conferences; lead discussions when needed.
• Develop care plans with members and address social needs with Community Health Partner support.
• Conduct regular visits and follow-ups per program guidelines; monitor interventions.
• Collaborate with care team to support members in health maintenance and chronic disease management.
• Perform medication reconciliation, administration, compliance, and education.
• Address quality gaps and ensure thorough chart documentation and coding (ICD/CPT).
• Use EHRs and scheduling platforms to document interactions and coordinate care.

Skills

Care coordination

Documentation

Interdisciplinary teamwork

Wound assessment

Phlebotomy

Adult & geriatric care

Willingness to travel

Education

RN license

Tools

EHR systems

ICD/CPT coding

Care coordination platforms

Job description

Cityblock Health, located in Fayetteville, NC, seeks a Registered Nurse Case Manager (RNCM) to oversee a panel of members with chronic conditions and support integrated medical and behavioral health care through collaborative care planning.

You will assess, plan, and coordinate care with a multidisciplinary team and Community Health Partner to address social needs and ensure high-quality care inside the program guidelines.