RN Case Manager: Elevate Patient Care & Coordination

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

Job summary

MedStar Health’s Washington Hospital Center is seeking a registered nurse with case management expertise to coordinate complex case management programs for members. Responsibilities include planning, monitoring, and coordinating care across medical, psychiatric, and social services to ensure timely, appropriate, and cost-effective care.

The role requires nursing licensure in DC or MD, 1–2 years in case management and UM, and 3–4 years of diverse clinical experience.

Qualifications

• Graduate of an accredited School of Nursing required.
• Bachelor's degree preferred.
• 1-2 years Case management experience required.
• 1-2 years UM or related experience required.
• 3-4 years Diverse clinical experience required.
• RN license in DC and/or MD based on work location; CCM preferred.

Responsibilities

• Contributes to department goals while following policies, procedures, quality and safety standards.
• Manages complex case management caseload and develops individualized plans of care per NCQA standards and DC Contract.
• Liaises with MedStar Family Choice contracted vendors to facilitate access to care.
• Advocates for members to coordinate medical, psychiatric, psychosocial, and social services; authorizes and monitors services per policy.
• Assists with discharge planning and recommends care level adjustments as needed.
• Participates in meetings and quality/service improvement initiatives and shares findings with staff.
• Delivers face-to-face case management in the community as needed.
• Maintains current knowledge of MFC benefits and enrollment issues to coordinate services.
• Documents interactions and program activities in the clinical software system per policy.
• Monitors utilization for fraud, waste, and abuse.

Skills

Verbal and written communication

Microsoft Office

Education

Graduate of an accredited School of Nursing

Bachelor's degree preferred

Tools

Microsoft Office

Job description

MedStar Health’s Washington Hospital Center is seeking a registered nurse with case management expertise to coordinate complex case management programs for members. Responsibilities include planning, monitoring, and coordinating care across medical, psychiatric, and social services to ensure timely, appropriate, and cost-effective care.

The role requires nursing licensure in DC or MD, 1–2 years in case management and UM, and 3–4 years of diverse clinical experience.