Registered Nurse; RN Care Manager

Job Title

Registered Nurse (RN) Care Manager

Western North Carolina Region

IPCNS seeks a compassionate and dedicated Registered Nurse (RN) Care Manager to provide patient‑centered care coordination and health education to individuals and families attributed to primary care practices in the network. The RN Care Manager will develop close working relationships with providers at assigned primary care practices and collaborate with a multidisciplinary care team to promote wellness, manage chronic diseases, and deliver preventative healthcare services.

• Enhance the quality of care and patient management throughout the continuum of care and assure cost‑effective care through clinical interventions, case management, education, chronic disease management, utilization review and management, and support of care transitions.
• Conduct and document clinical assessments and create care plans for patients identified as high risk or having unmet needs or barriers to care.
• Provide support to patients, family, caregivers, providers, and community agencies.
• Collaborate with network and community partners to achieve positive individual and population outcomes, promote best practices, and improve healthcare delivery.
• Conduct visits with patients based on program guidelines.
• Assess assigned patients’ “whole person” needs by completing a comprehensive assessment, including review of functional abilities, social determinants of health, clinical findings, medical records, and current supports and services.
• Responsible for clinical management of high‑risk identified patients.
• Provide education, support, and guidance in a patient‑centered manner for the significant health conditions and social needs of the assigned patient population.
• Create, monitor, and evaluate the effectiveness of the patient‑centered plan of care to address all assessed needs.
• Communicate clinical findings, recommendations, and referrals to the care team.
• Follow all applicable regulatory requirements related to clinical interventions and documentation.
• Support network goals of managing clinical quality measures.
• Use population health platform and/or available data to identify patients at risk and target appropriate interventions.
• Support patients transitioning from one level of care to another by identifying and addressing needs and barriers related to successful transitions.
• Coordinate transition plans with patients, family, caregivers, providers, and community agencies.
• Collaborate with patients and caregivers to identify needs for post‑acute services, such as durable medical equipment, home health, outpatient services, and community resources; facilitate orders as indicated and follow through with referrals as appropriate.
• Communicate changes in plan of care and incremental goals to patient/family, caregivers, and providers.
• Prepare and deliver internal education to staff as appropriate.

Required

Education:

Bachelor of Science in Nursing (BSN) or Associate Degree in Nursing (ADN) with a Bachelor of Public Health or related field.

Preferred Education:

Master of Science in Nursing (MSN).

Required Certification/License:
Current Registered Nurse (RN) license in North Carolina. Compact License accepted.

Preferred Certification/License:
Accredited Case Manager (ACM‑RN), Certified Case Manager (CCM), or related certification.

Required

Work Experience:

3 years in clinical nursing in a relevant practice area for BSN/ADN candidates or 1 year for MSN candidates.

Preferred

Work Experience:

Prior experience in community or public health nursing or nurse care management.

Ongoing:
Maintains licensure, knowledge, and competencies related to clinical care coordination and practices within scope.

• Strong communication and interpersonal skills.
• Ability to work independently and as part of a multidisciplinary team, demonstrating strong self‑management and an entrepreneurial mindset.
• Demonstrates sensitivity and professionalism when interacting with individuals from a wide range of backgrounds.
• Shows dedication to providing quality healthcare by ensuring everyone receives the care and resources they need.
• Wil…