Registered Nurse Care Manager

OUR PHILOSOPHY

Blue Zones Health is creating a Well-Being Services Organization built around a complete and integrated understanding of each member's health, needs, goals, and circumstances. Clinical Management plays a critical role in ensuring members—particularly those with chronic conditions, complex medical needs, and recent transitions of care—receive coordinated, proactive, and personalized support.

Blue Zones Health is creating a Well-Being Services Organization built around a complete and integrated understanding of each member's health, needs, goals, and circumstances. Clinical Management plays a critical role in ensuring members—particularly those with chronic conditions, complex medical needs, and recent transitions of care—receive coordinated, proactive, and personalized support.

The RN Care Manager provides comprehensive clinical care management for Blue Zones Health members, with a primary focus on chronic disease management, high- and rising-risk populations, Special Needs Plan (SNP) Model of Care requirements, and transitions of care following inpatient, skilled nursing facility, and emergency department encounters.

The RN Care Manager conducts comprehensive clinical assessments, develops and monitors individualized care plans, coordinates services across the healthcare continuum, and serves as a clinical liaison among members, caregivers, providers, specialists, community organizations, and internal interdisciplinary teams.

Working closely with Population Health and Well-Being Services, the RN Care Manager integrates clinical care coordination with lifestyle medicine, self-management strategies, community resources, and holistic approaches that support improved health outcomes, reduced avoidable utilization, and long-term member well-being.

Budgeted Compensation: $110,000-$120,000

• Chronic Disease & Population Health Management
• Partner with the Population Health team to identify high- and rising-risk members using available data, clinical information, utilization patterns, and risk stratification tools
• Conduct comprehensive clinical assessments through telehealth and telephonic outreach, evaluating medical, functional, psychosocial, environmental, and behavioral factors affecting member health
• Perform medication reconciliation and identify potential barriers to medication adherence, treatment plans, and disease self-management
• Develop, implement, and continuously monitor individualized care plans in partnership with members, caregivers, providers, and the interdisciplinary care team
• Support members and caregivers in understanding chronic conditions, treatment plans, preventive care needs, medication adherence, and lifestyle modifications
• Identify barriers to care and develop practical strategies to support member engagement and successful self-management
• SNP Model of Care & Regulatory Compliance
• Support implementation and execution of SNP-specific Model of Care requirements, including health risk assessments, individualized care plans, care coordination, and interdisciplinary care processes
• Ensure assigned members receive appropriate care management activities consistent with SNP requirements and organizational standards
• Participate in interdisciplinary care team meetings and case discussions involving complex and high-risk members
• Support SNP-related quality improvement activities and ongoing efforts to strengthen care coordination and member outcomes
• Maintain awareness of applicable regulatory, health plan, NCQA, CMS, and organizational requirements relevant to care management activities
• Ensure required assessments, care plans, interventions, and follow-up activities are completed and documented within established…