Care Manager (RN

Title:
Care Manager (RN)

Duration: 03 Months
- Possible extension

Location:
Remote
- Florida

Monday
- Friday 8am to 5pm No overtime required.

The Care Manager RN serves as the clinical lead for assigned members, focusing on maternal-child health and high-risk Medicaid populations. Daily responsibilities include reviewing referrals and risk stratification reports, conducting comprehensive Trimester based assessments, developing and updating individualized care plans, coordinating services with providers and community partners, completing member outreach, addressing gaps in care, and documenting interventions in the care management platform.

Care Managers collaborate closely with physicians, hospitals, behavioral health providers, Healthy Start programs, community agencies, and internal interdisciplinary teams to improve member outcomes. Care Managers are also responsible for supporting transitions of care, identifying social determinants of health needs, facilitating referrals, and ensuring members receive appropriate services throughout pregnancy, postpartum, and other care management programs.

The role supports key maternal-child health initiatives, including high-risk pregnancy management, postpartum engagement, First Year of Life (FYOL), behavioral health integration, and other population health programs designed to improve quality outcomes and reduce healthcare disparities.

This role offers the opportunity to directly impact maternal and child health outcomes while working with some of the most vulnerable and complex Medicaid populations. Unlike traditional bedside nursing, the Care Manager RN functions as a clinical coordinator, advocate, educator, and population health strategist. The role combines clinical expertise, care coordination, behavioral health integration, social determinants of health interventions, and community partnership development.

The position provides exposure to innovative programs and initiatives focused on high-risk pregnancies, postpartum support, infant wellness, behavioral health integration, and health equity. Care Managers work independently in a remote environment while partnering with a multidisciplinary team committed to improving outcomes for members and families across the continuum of care.

This role is ideal for an RN who enjoys autonomy, critical thinking, relationship building, population health management, and making a measurable impact on maternal and infant health outcome

Performance is measured through a combination of quality, productivity, compliance, and member engagement metrics, including:

• Timely acceptance and management of assigned referrals and cases.
• Completion of required assessments, care plans, and documentation within established time frames.
• Adherence to outreach requirements and member engagement expectations.
• Successful closure or graduation of cases based on program goals and member outcomes.
• Care plan quality and interdisciplinary care team collaboration.
• Transition of Care (TOC) compliance and post-discharge follow-up completion.
• Regulatory, NCQA, state, and health plan documentation standards.
• Productivity and case management efficiency metrics tracked through organizational reporting and care management dashboards.

Education/Certification

• Required:
  
  3 years of recent RN clinical experience.
• 5+ years of nursing experience with care management, case management, maternal-child health, OB, NICU, pediatrics, population health, Medicaid, managed care, or community health experience.
• Preferred:
  Case Management experience

Licensure

• Required:
  
  RN
• Preferred: NA

Years of experience required:
Minimum: 3 years of recent RN clinical experience. 5+ years of nursing experience with care management, case management, maternal-child health, OB, NICU, pediatrics, population health, Medicaid, managed care, or community health experience. Active, unrestricted RN license required

Disqualifiers:

• No active RN license
• Less than 3 years of nursing experience
• No experience managing high risk OB member/populations or coordinating care across multiple disciplines
• Inability to work independently in a remote environment
• Limited computer proficiency or difficulty navigating multiple systems simultaneously
• Poor documentation, time management, or organizational skills
• No experience conducting telephonic member outreach and engagement (preferred for experienced candidates)

Additional qualities to look for:

• Strong critical thinking and clinical assessment skills
• Exceptional communication and motivational interviewing abilities
• Ability to build rapport with diverse member populations
• Highly organized and self-directed
• Strong problem-solving skills
• Ability to prioritize a large caseload and competing priorities
• Passion for improving maternal and infant health outcomes
• Experience collaborating with community resources, providers, hospitals, and interdisciplinary teams
• Adaptability in a fast-paced and changing healthcare environment
• Data-driven mindset with focus on quality outcomes and…