RN Case Manager: Lead Care Coordination (Sign-On Eligible)

CVS Health; Lancaster (Lancaster County); On-site; USD 61,000 - 130,000; Full time

Benefits offered by this job

Health insurance

401K match

Paid time off

Education stipends

Job summary

Oak Street Health is hiring an RN, Case Manager to lead care management for complex patients in a field-based, on-site role across Bethlehem and surrounding communities. You will drive care coordination, prevent avoidable admissions, and partner with PCPs and interdisciplinary teams to ensure seamless transitions of care.

The role emphasizes patient education, timely documentation in EHR, and a proactive approach to optimization of resources while maintaining strong patient and family engagement

Qualifications

• Current RN license in the assigned state; CCM preferred or willing to obtain within 12 months.
• 6–8 years nursing experience.
• 2+ years in transitional nursing, care coordination, discharge planning, or home health.
• Strong motivational interviewing and patient activation skills.
• Willingness to travel in Oak Street Health communities and reliable transportation.

Responsibilities

• Lead care management for a panel of complex patients in a value-based model.
• Drive admission prevention, readmission prevention, and transitions of care metrics.
• Own overall care coordination and serve as primary contact across the care team.
• Coordinate post-discharge transitions and medication reconciliation with PCP.
• Collaborate with PCPs, families, social workers and behavioral health as needed.

Skills

RN license

CCM certification

Care coordination

Transitional nursing

Education

BSN preferred

Job description

Oak Street Health is hiring an RN, Case Manager to lead care management for complex patients in a field-based, on-site role across Bethlehem and surrounding communities. You will drive care coordination, prevent avoidable admissions, and partner with PCPs and interdisciplinary teams to ensure seamless transitions of care.

The role emphasizes patient education, timely documentation in EHR, and a proactive approach to optimization of resources while maintaining strong patient and family engagement