Case Manager - Registered Nurse
Listed on 2026-11-04
-
Nursing
RN Nurse, Nurse Practitioner, Healthcare Nursing
Wichita, United States | Posted on 10/26/2026
- Salary Competitive exempt salary based on experience, education, and qualifications.
- State/Province Kansas
- Country United States
Department: Integrated Health Management (IHM)
Reports To: RN Supervisor / Director of Integrated Health Management
Employment Status: Full-Time
FLSA Classification: Non-Exempt
Work Location: On-Site
Schedule: Monday–Friday 8a-5p, or 10a-7p
Position Summary - This is an on-site job position in Wichita, KSThe RN Case Manager is responsible for providing comprehensive, member-centered case management services to individuals covered under employer-sponsored, self-funded health plans administered by the Third-Party Administrator (TPA).
This position focuses on identifying high-risk and high-cost members, assessing clinical and psychosocial needs, developing individualized care plans, coordinating healthcare services, and promoting appropriate, cost-effective care.
The RN Case Manager works collaboratively with members, healthcare providers, Utilization Review (UR) Nurses, Care Navigators, Pharmacy Benefit Managers (PBMs), and other healthcare partners to improve health outcomes, reduce avoidable healthcare utilization, and support members in navigating the healthcare system.
The RN Case Manager serves as a clinical advocate for members while supporting the TPA's commitment to quality care, appropriate resource utilization, and responsible management of employer health plan expenditures.
Essential Duties and Responsibilities1. Comprehensive Member Assessment and Case Management
Conduct comprehensive initial and ongoing assessments addressing medical conditions, medications, functional limitations, behavioral health concerns, and social determinants of health (SDOH).
Identify members who may benefit from case management through utilization reports, claims data, hospital admissions, referrals, and other available clinical information.
Evaluate members' understanding of their diagnoses, treatment plans, medications, and healthcare needs.
Develop, implement, and regularly update individualized, measurable care plans in collaboration with members and their healthcare providers.
Establish short-term and long-term goals based on identified clinical needs and member priorities.
Monitor member progress, evaluate interventions, and modify care plans as necessary.
Maintain an assigned caseload and prioritize interventions according to member acuity, risk, and clinical complexity.
2. Care Coordination and Transitions of CareCoordinate healthcare services across primary care providers, specialists, hospitals, rehabilitation facilities, home health agencies, and other healthcare settings.
Facilitate safe and timely transitions between levels of care, including hospital discharge and post-acute care.
Conduct post-discharge outreach to assess member needs, reinforce discharge instructions, and identify potential complications.
Assist members with accessing appropriate providers, diagnostic services, durable medical equipment, and community resources.
Identify gaps in care and facilitate interventions to reduce unnecessary emergency department visits, hospitalizations, and readmissions.
Collaborate with Care Navigators to address appointment scheduling, provider access, network utilization, and nonclinical member needs.
3. Chronic Disease Management and Member EducationProvide individualized education regarding chronic conditions, treatment recommendations, medications, preventive care, and lifestyle modifications.
Support members managing conditions such as diabetes, hypertension, cardiovascular disease, chronic obstructive pulmonary disease, and other complex medical conditions.
Promote adherence to recommended treatment plans and follow-up appointments.
Assess member readiness to change and identify barriers affecting self-management.
Utilize motivational interviewing, teach-back methods, and other evidence-based approaches to encourage member engagement.
Promote preventive screenings, vaccinations, and appropriate routine healthcare services.
4. Medication Management and Pharmacy CollaborationPerform medication reconciliation and review prescribed medications for potential adherence concerns, duplication, access barriers, and affordability issues.
Collaborate with Pharmacy Benefit Managers (PBMs), pharmacists, prescribers, and specialty pharmacy partners to support appropriate medication therapy.
Identify opportunities for clinically appropriate, lower-cost…
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