RN Case Manager: Complex Care Navigator

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

Job summary

MedStar Health is seeking a Registered Nurse to manage complex case loads and coordinate care for members enrolled with MedStar Family Choice. This role emphasizes NCQA standards, quality care, and cost-effective service delivery across medical, psychiatric, psychosocial and other essential needs.

Responsibilities include developing individualized care plans, advocating for access to services, coordinating with hospitals and external partners, documenting thoroughly, and participating in

Qualifications

• RN license required; District of Columbia and/or Maryland licensure based on work location.
• CCM certification is preferred.
• 1-2 years case management and 1-2 years UM or related experience; 3-4 years diverse clinical experience.

Responsibilities

• Coordinate and manage a complex case management caseload in accordance with NCQA standards and DC contract.
• Act as liaison to MedStar Family Choice contracted vendors to facilitate access to care.
• Advocate for members/enrollees to coordinate and obtain medical, psychiatric, psychosocial, and other services.
• Assist with discharge planning and provide recommendations on care levels as acuity necessitates.
• Document timely and accurate information in the clinical software system and monitor utilization for quality and safety.

Skills

Verbal communication

Written communication

Computer skills

MS Office

Education

RN Licensure

Bachelor's degree preferred

Job description

MedStar Health is seeking a Registered Nurse to manage complex case loads and coordinate care for members enrolled with MedStar Family Choice. This role emphasizes NCQA standards, quality care, and cost-effective service delivery across medical, psychiatric, psychosocial and other essential needs.

Responsibilities include developing individualized care plans, advocating for access to services, coordinating with hospitals and external partners, documenting thoroughly, and participating in