RN Case Manager

Job Title:

RN Case Manager – Medicare Advantage Job Description

This role provides telephonic case management for Medicare Advantage members in Florida, focusing on comprehensive care coordination, clinical assessments, and ongoing support. The RN Case Manager develops and manages individualized care plans, collaborates with members and healthcare providers, and documents all activities in the Athena electronic medical record (EMR) system. This position is ideal for an experienced Florida‑licensed RN who genuinely enjoys case management and is motivated by improving patient outcomes through proactive, organized, and compassionate care.

• Perform telephonic case management for Medicare Advantage members residing in Florida.
• Conduct comprehensive clinical assessments to identify members’ medical, functional, and psychosocial needs.
• Develop, implement, and update individualized care plans based on assessments, member goals, and clinical guidelines.
• Coordinate care across various settings, including hospital, acute care, home health, and hospice, to ensure continuity of care.
• Manage new referrals by reviewing clinical information, initiating outreach, and determining appropriate case management interventions.
• Call members regularly to monitor health status, reinforce care plans, provide education, and address emerging needs or concerns.
• Build, maintain, and update member cases in the Athena EMR platform, ensuring accurate and timely documentation of all interactions and interventions.
• Handle a caseload of at least 73 members, prioritizing tasks and managing time effectively to meet clinical and operational expectations.
• Utilize strong triage skills to identify urgent needs, elevate issues appropriately, and support safe, timely care decisions.
• Review and interpret medical records and clinical documentation to support care planning and utilization management activities.
• Collaborate with physicians, care teams, and community resources to coordinate services and support optimal patient outcomes.
• Apply managed care and utilization management principles to ensure appropriate use of healthcare resources.
• Deliver high‑quality customer service to members and their families, addressing questions and concerns with professionalism and empathy.
• Use Microsoft Office tools, including Excel, for data entry, tracking, and reporting related to case management activities.
• Maintain thorough, accurate, and compliant documentation of all member interactions, assessments, and care‑coordination activities in the EMR.
• Work effectively in a fast‑paced, high‑acuity environment while maintaining attention to detail and clinical quality.
• Demonstrate a strong commitment to case management as a primary professional focus, contributing to a culture of patient‑centered care.

• Active Registered Nurse (RN) license in the state of Florida.
• At least 2 years of case management experience in hospital, acute care, home health, or hospice settings.
• Experience with Athena EMR software/platform for documentation and case management.
• Demonstrated case management and care management experience, including care coordination and care‑plan development.
• Experience in managed care and utilization management within a healthcare setting.
• Strong computer skills, including proficiency with Microsoft Office Suite and Excel.
• Accurate and efficient data entry and electronic documentation skills.
• Proven ability to handle a caseload of at least 73 members while maintaining quality and compliance.
• Experience working in fast‑paced and high‑acuity nursing environments.
• Strong triage skills and the ability to interpret medical records and clinical information.
• Excellent customer service and communication skills when interacting with patients, families, and healthcare teams.
• Demonstrated commitment to and genuine interest in case management work.

• Experience in telephonic case management for Medicare or Medicare Advantage populations.
• Prior experience in home health or hospice case management.
• Familiarity with patient care workflows across multiple care settings, including hospital and post‑acute environments.
• Ability to work…