RN Care Manager

REMOTE Clinical Care Manager (RN)

**Must be licensed in NY state and commutable to NYC**

Job Overview:

We are seeking dedicated Registered Nurses (RNs) to join our team, specializing in Medicaid care management. Our mission is to deliver personalized, evidence-based care that empowers patients to manage their health safely within their homes and communities. As a Clinical Care Manager, you will play a crucial role in coordinating healthcare benefits and services, ensuring high-quality, cost-effective care for a diverse patient population.

Key Responsibilities:

• Coordinate and oversee benefits and services for all members on your caseload.
• Complete care management and disease-specific assessments.
• Conduct timely telephonic care management calls based on risk levels.
• Resolve complex issues and member complaints related to service delivery.
• Provide health education to members and caregivers.
• Assess Social Determinants of Health (SDoH) and coordinate care to reduce barriers.
• Identify and address member safety issues, referring to appropriate resources when necessary.
• Advocate for members/caregivers to optimize their quality of life.
• Promote adherence to physician treatment plans through education, coaching, and support.
• Increase utilization of primary care, specialty care, preventive health, and guideline-based treatments.
• Participate in interdisciplinary team (IDT) meetings, providing input on customer service-related activities.
• Protect the confidentiality of member information and ensure compliance with company policies and regulations.

Qualifications:

• Associate degree in nursing or a bachelor's degree in nursing required.
• Minimum two years of experience as a registered nurse.
• Active and current license as a Registered Professional Nurse in the State of New York.
• Population Care Coordination Certification preferred.
• Care Management, Case Management, OASIS, or other application certification preferred.

Preferred Background:

• Experience with patients diagnosed with HIV, or familiarity with HIV care.
• Experience in care management, especially within Medicaid.
• Experience in transgender care or mainstream/traditional Medicaid.
• Spanish bilingual skills are highly desirable.

Caseload:

• Manage a caseload of approximately 250 members, with a CMSC partner. Outreach calls will be rotated monthly, with flexibility for clinical needs.

Work Environment:

• Primarily remote, with potential in-office requirements up to 6 times a year (subject to increase). Flexibility is expected.

Join us in making a meaningful impact in the lives of our patients, helping them navigate their healthcare journey with confidence and support. Apply today to become a part of our dedicated team! #medixeast