RN Bilingual Case Manager - Breast & Cervical Cancer Outpatient Program

About the Job

The RN Case Manager provides community‑based care coordination and clinical support as part of a small, collaborative team serving predominantly Spanish‑speaking women 40 years and older in Baltimore City. This office‑based role focuses on telephonic patient engagement, triage, and clinical assessment to support access to services and continuity of care. The RN Case Manager utilizes strong clinical judgment and acute care experience to identify patient needs, coordinate resources, and promote positive health outcomes.

This state grant–funded position offers a fixed annual salary of $86,000 with annual cost‑of‑living increases. Some travel within Baltimore City is required. The role offers a structured workflow while delivering meaningful community impact. The RN Case Manager facilitates quality, cost‑effective patient‑centered care from pre‑admission through post‑discharge, ensuring individualized outcomes.

• Contributes to the achievement of established department goals and objectives and adheres to department policies, procedures, quality standards, and safety standards. Complies with governmental and accreditation regulations.
• Collaborates with the multidisciplinary health care team to develop and coordinate the plan of care.
• Communicates daily with direct care givers and the case management triad regarding patient and family responses to the plan of care, identification of problems, discharge planning, and payer concerns such as LOS. Collaborates with utilization review team members on medical necessity determinations. Refers cases that need intervention.
• Communicates with patient family and/or significant other to identify and clarify patient and family goals.
• Communicates with patient family and/or significant other, health care team, external case manager, and facility to address issues relating to transition from acute to post‑hospital care. Escalates issues to physician advisors and/or supervisors as necessary.
• Conducts a pre/post admission assessment to identify patients for case management based on high‑risk screen indicators. Performs a comprehensive assessment incorporating data from other disciplines to identify patient‑specific problems or needs related to diagnosis, treatment, and discharge planning.
• Demonstrates competency in the area of specialty to meet age‑specific biopsychosocial and spiritual needs of patients served.
• Disseminates and applies knowledge to meet the educational needs of the health care team, community, patients, and families. Uses readmission prevention risk identification systems to manage the assigned population and communicates plan of care and barriers to the interdisciplinary care team. As appropriate, communicates daily with direct care givers and the case management triad regarding readmission risk factors, care transition plans, and post‑acute services.
• Evaluates and documents the patient’s response to the plan of care and achievement of outcomes. Makes recommendations for modifications to the plan as indicated. Evaluates effectiveness of clinical pathways through outcome analysis, variance tracking, and problem identification.
• Manages a caseload of patients from admission through discharge and readmission when appropriate. Identifies essential resources needed to implement the plan of care. May initiate discharge plans in collaboration with the patient/family and health care team, meeting mutually set goals as clinically and financially feasible. Delegates specialized patient care needs and planning to team members such as community health advocates, peer recovery coaches, complex case managers, and social workers.
  
  May maintain a post‑discharge caseload of assigned patients with timely telephonic calls to ensure discharge and follow‑up plans are adhered to.
• Manages own professional growth in managed care and health care financial trends, clinical practice, readmissions, and research.
• Manages patient care according to clinical pathways or multidisciplinary plans, identifying and managing barriers that impact patient outcomes. Identifies delays and communicates appropriately.
• Maintains knowledge of regulatory…