RN Case Manager: Complex Care & Care Coordination

MedStar Health; Washington (District of Columbia); On-site; USD 89,000 - 163,000; Full time

Job summary

MedStar Health in Washington, DC area seeks an RN Case Manager for the Health Home Program to coordinate and manage care for members. You will negotiate, facilitate access, and ensure cost-effective, quality care across medical and behavioral health services.

The role requires knowledge of NCQA standards, HEDIS gaps, and strong collaboration with interdisciplinary teams. A nursing degree and DC/MD licensure are required or in place, with CCM preferred.

Qualifications

• Graduate of an accredited School of Nursing is required.
• 1-2 years case management experience required and
• 1-2 years UM or related experience required
• 3-4 years Diverse clinical experience required

Responsibilities

• Coordinate, negotiate, procure, and manage member care to facilitate cost-effective, quality outcomes.
• Act as liaison to MedStar Family Choice vendors to facilitate access to care.
• Maintain timely and accurate documentation in the clinical software system per policy.
• Participate in meetings and committees and contribute to program goals.

Skills

Verbal and written communication

Data entry and retrieval

Education

Nursing degree required

Bachelor's degree preferred

Tools

Microsoft Office

Job description

MedStar Health in Washington, DC area seeks an RN Case Manager for the Health Home Program to coordinate and manage care for members. You will negotiate, facilitate access, and ensure cost-effective, quality care across medical and behavioral health services.

The role requires knowledge of NCQA standards, HEDIS gaps, and strong collaboration with interdisciplinary teams. A nursing degree and DC/MD licensure are required or in place, with CCM preferred.