Manages a panel of clinically complex members to support impactable clinical programs, quality gap initiatives and ED and IP utilization
Collaborates with members to create a care plan and oversees progress to the plan
Completes self-efficacy and condition-specific screeners during the assessment and intake phase
Refers members to behavioral health programs as needed
Develops a care plan in collaboration with the member, addressing social needs
Conducts regular clinical visits and follow-ups per clinical program and pathway guidelines
Performs medication reconciliation, administration, compliance, and education as part of member care
Utilizes care facilitation tools, electronic health records, and scheduling platforms to gather data

Graduate of an accredited school of nursing (R.N.)
3+ Years of experience
Strong critical thinker with sound clinical judgment who makes complex decisions independently and knows when to collaborate
Identifies system barriers to care and develops creative, practical solutions
Strong written and verbal communicator across phone, text, virtual, and in-person settings
Comfortable using technology to engage members remotely
Applies Motivational Interviewing and Trauma-Informed Care principles to build trust
Effectively translates clinical information for non-clinical audiences and actively listens to understand and address needs.

RN Care Manager

Key skills