Registered Nurse - Care Manager (Full-time, Monday-Friday

Position: Registered Nurse - Care Manager (Full-time, Monday-Friday)
Location: Eureka Springs

Organization Overview, Mission, Vision, and Values Our mission is to improve the health of people in the communities we serve through compassionate, high-quality care, prevention, and wellness education. Washington Regional Medical System is a community-owned, locally governed, non-profit health care system located in Northwest Arkansas in the heart of Fayetteville, which is consistently ranked among the Best Places to live in the country.

Our 425-bed medical center has been named the #1 hospital in Arkansas for five consecutive years by U.S. News & World Report. We employ 3,200+ team members and serve the region with over 40 clinic locations, the region’s only Level II trauma center, and five Centers of Excellence - the Washington Regional J.B. Hunt Transport Services Neuroscience Institute;
Washington Regional Walker Heart Institute;
Washington Regional Women and Infants Center;
Washington Regional Total Joint Center; and Washington Regional Pat Walker Center for Seniors.

Position Summary The Care Manager (CM) supports patients across the care continuum by performing nurse-led Medicare Annual Wellness Visits (AWVs), providing case management and complex care management, and driving enrollment in Advanced Primary Care Management (APCM). This role works closely with providers and clinical operations to close care gaps, improve quality outcomes, and support patients with chronic and complex needs in a value-based care environment.

The CM operates within Epic and other care management platforms to document, track, and coordinate patient care activities.

Essential Position Responsibilities Nurse-Led Medicare Annual Wellness Visits (AWV)
Independently perform nurse-led AWVs under applicable state scope of practice and CMS direct supervision requirements

Conduct the full AWV visit, including Health Risk Assessments (HRAs), cognitive screenings, functional/safety screenings, and development of a personalized prevention plan Review and reconcile medication lists, screening histories, and immunization status with the patient

Document the visit to meet CMS requirements for AWV billing (G0438/G0439)
Identify and close associated quality measure gaps during the visit, per established protocols

Escalate any clinical concerns to the supervising provider for review and sign-offCase Management Conduct patient assessments to identify medical, behavioral, and social needs

Coordinate referrals to community resources.

APCM Enrollment Identify patients eligible for Advanced Primary Care Management based on CMS risk stratification criteria

Educate patients and caregivers on APCM program benefits and obtain consent for enrollment

Coordinate with billing/compliance staff to ensure documentation supports appropriate service level.

Complex Care Management Manage a caseload of patients with multiple chronic conditions, high utilization, or elevated risk scores

Develop and maintain individualized care plans in collaboration with the care team Perform regular outreach (telephonic, MyChart, in-person) to monitor status and reinforce care plans

Provide patient and caregiver education on diagnoses, treatment plans, and self-management

Collaborate with interdisciplinary team members on complex cases

Escalate urgent clinical concerns per established protocols

Documentation & Quality Maintain accurate, timely documentation in Epic consistent with organizational and regulatory standards

Support HEDIS and other quality measure compliance through accurate coding and gap closure documentation

Participate in quality improvement initiatives and case reviews

Track and report on productivity and outcome metrics as defined by leadership

Qualifications Required Current , unencumbered RN license in the state of Arkansas Minimum 2 years of clinical experience in primary care, case management, or care coordination

Strong understanding of Medicare AWV, CCM, and/or APCM program requirements

Proficiency with EHR systems (Epic preferred)
Excellent communication, organization, and interpersonal skills

Preferred

Experience in a value-based care or ACO environment

Familiarity with HEDIS quality measures

Case Management certification (CCM) or willingness to obtain within a defined timeframe

Experience with population health/risk stratification tools

Core Competencies Patient-centered communication and motivational interviewing

Time management across a mixed caseload (scheduled visits, telephonic outreach, documentation)
Critical thinking and clinical judgment for escalation decisions

Collaborative, team-based approach to care delivery

Comfort with data tracking and quality metric reporting

Work Environment:
This role requires a combination of clinical and office-based activity. The position may involve extended periods of standing and walking, as well as occasional pushing, pulling, lifting, or carrying materials up to 50 pounds. The role also includes time spent sitting and working in a standard office environment. Depending on the care setting, the position may be exposed to communicable…