RN Case Manager - Care Coordination Leader

CVS Health; Cleveland (OH); On-site; USD 61,000 - 130,000; Full time

Benefits offered by this job

Health insurance

Vision and dental benefits

Paid time off

401K match

Job summary

Oak Street Health is seeking an experienced RN, Case Manager in Cleveland, OH to lead care coordination for a panel of complex patients in a value-based care setting. This field-based, in-person role partners closely with PCPs, social workers and the care team to prevent avoidable admissions and optimize transitions of care.

The ideal candidate holds an active RN license, CCM certification, 6–8 years of nursing experience, and a track record in care coordination, discharge planning or home

Qualifications

• RN license is required in the assigned state.
• Certified Case Manager (CCM) is required or to be obtained within 12 months of hire.
• 2+ years experience in transitional nursing, care coordination, discharge planning, or home health is strongly preferred.
• Demonstrated skill in motivational interviewing, patient activation, time management, and navigating community resources.

Responsibilities

• Manages an assigned caseload of complex patients in a value-based care environment, aiming to reduce admissions and readmissions.
• Accountable for panel metrics in admission prevention and transitions of care.
• Owns overall care coordination for assigned patients and serves as the primary point of contact for the care team.
• Manage transitions of care episodes, complete structured clinical assessments, and coordinate post-discharge needs.
• Collaborate with PCP, family/caregiver, Social Worker, Behavioral Health Specialists and other team members to align the care plan.

Skills

RN license

CCM

Nursing experience

Care coordination

Discharge planning

Education

Bachelor degree in nursing

Job description

Oak Street Health is seeking an experienced RN, Case Manager in Cleveland, OH to lead care coordination for a panel of complex patients in a value-based care setting. This field-based, in-person role partners closely with PCPs, social workers and the care team to prevent avoidable admissions and optimize transitions of care.

The ideal candidate holds an active RN license, CCM certification, 6–8 years of nursing experience, and a track record in care coordination, discharge planning or home