RN Clinical Case Manager: Care Coordination & Outcomes

CareMore Health; United States; Remote; USD 81,000 - 122,000; Full time

Job summary

CareMore Health is seeking a Clinical Case Manager, RN to coordinate and manage care for members with complex medical and psychosocial needs within a value-based care model.

You will collaborate with providers, patients, families, and care teams to assess needs, develop individualized care plans, and facilitate services across the continuum of care, aiming to improve outcomes and reduce unnecessary hospitalizations.

Responsibilities

• Assess, plan, facilitate, coordinate, monitor, and evaluate services to meet the healthcare needs of members, particularly those with complex or high-risk conditions.
• Develop and implement comprehensive clinical case management plans tailored to each patient’s medical, behavioral, and social needs.
• Collaborate with physicians, advanced practice providers, and interdisciplinary care teams to support evidence-based care and effective disease management.
• Monitor patient progress and revise care plans as needed to address changes in clinical status or care needs.
• Identify and address barriers to care including social determinants of health, treatment adherence challenges, or gaps in services.
• Analyze patient variances from the established care plan and initiate appropriate interventions to resolve issues and improve outcomes.
• Support CareMore’s value-based care model by focusing on improved outcomes, care coordination, and appropriate utilization of healthcare services.
• Manage high-risk or medically complex patients with chronic conditions such as heart failure, diabetes, COPD, and other conditions requiring ongoing care coordination.
• Collaborate with care teams to proactively manage patients who are at risk for hospitalization or complications.
• Promote preventive care, chronic disease management, and patient engagement strategies that improve long-term health outcomes.
• Support members and their representatives regarding care needs, care transitions, and changes in health status.
• Serve as a liaison between patients, providers, and care teams to facilitate coordinated care delivery.
• Coordinate services across multiple care settings including primary care, specialty care, hospitals, skilled nursing facilities, home health agencies, and community-based resources.
• Provide education and support to patients and families regarding treatment plans, medications, and self-management strategies.
• Support smooth transitions between care settings to reduce complications, readmissions, and unnecessary healthcare utilization.
• Maintain accurate, complete, and timely documentation in accordance with organizational policies and regulatory requirements.
• Ensure compliance with applicable clinical protocols, utilization management guidelines, and federal and state regulations.
• Maintain strict confidentiality of member information in accordance with HIPAA and other regulatory standards.

Job description

CareMore Health is seeking a Clinical Case Manager, RN to coordinate and manage care for members with complex medical and psychosocial needs within a value-based care model.

You will collaborate with providers, patients, families, and care teams to assess needs, develop individualized care plans, and facilitate services across the continuum of care, aiming to improve outcomes and reduce unnecessary hospitalizations.