Care Manager

We are seeking an experienced RN Care Manager to provide health coaching, case management, and care coordination services to members across the healthcare continuum, from health promotion and preventive care through chronic, complex, and end-of-life care.

The RN Care Manager serves as a primary clinical resource for members, working closely with patients, families, physicians, and other members of the healthcare team. This position is responsible for assessing member needs, developing individualized care plans, establishing health goals, coordinating services, and helping members navigate the healthcare system.

• Provide health coaching and case management based on each member's individual needs and level of clinical complexity.
• Conduct comprehensive assessments and screenings to proactively identify healthcare needs, risks, and barriers to care.
• Develop individualized care plans and health goals in collaboration with members, families, physicians, and other healthcare professionals.
• Use motivational interviewing and clinical coaching techniques to promote positive behavior change, treatment adherence, and member self-management.
• Provide telephonic clinical support and education to members seeking assistance with acute symptoms, chronic conditions, and health-related questions.
• Maintain ongoing communication with members to monitor progress toward established goals and identify when adjustments to the care plan may be needed.
• Coordinate with physicians and other healthcare providers, particularly for members with complex medical needs requiring additional case management intervention.
• Help members understand and navigate their healthcare benefits and available services, while connecting them with appropriate community, telephonic, and online resources.

• Current, active, and unrestricted Pennsylvania Registered Nurse (RN) license required.
• Minimum of 3 years of experience in a combination of clinical nursing, case management, care management, and/or disease/condition management.
• Strong clinical knowledge and assessment skills.
• Excellent communication and interpersonal skills.
• Basic computer and clinical documentation skills.

• Telephonic or remote care/case management experience.
• Health plan, managed care, or health insurance experience.
• Experience developing and monitoring individualized care plans.
• Experience coordinating care with physicians and multidisciplinary healthcare teams.
• Case management certification, such as CCM
  , is a plus.