RN Care Manager – Complex Care & High Utilizer Management
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Job Description
RN Care Manager managing participants with complex needs and high utilization of healthcare services. Collaborating with providers to implement strategies for better chronic disease management.
Responsibilities:
- The RN Care Manager – Complex Care & High Utilizer Management is responsible for the comprehensive management of participants who exhibit high utilization of outpatient services.
- Provide advanced clinical oversight, risk stratification, and proactive outreach to ensure participants receive timely, coordinated, and appropriate care.
- Collaborate closely with medical providers, behavioral health specialists, and operational leaders to develop and implement strategies that reduce avoidable utilization.
- Deliver ongoing care, support, and health education to participants with chronic illnesses.
- Oversee the referral process for high-risk and complex participants to ensure clinical appropriateness and timeliness.
- Monitor utilization patterns and proactively engage participants to reduce unnecessary service use.
Requirements:
- BSN required
- Current Registered Nurse (RN) license in New York State
- Certification in Case Management (CCM) or equivalent, preferred
- 3+ years of clinical experience in chronic disease management, care coordination, or case management
- Experience working with high‑risk, medically complex, or high‑utilizing populations
- Strong assessment, communication, and interdisciplinary collaboration skills.
- Experience in PACE, MLTC, Managed Care, or high‑risk care management preferred
- Prior experience with behavioral health integration or complex psychosocial case management preferred
Benefits:
- Health insurance
- Flexible working arrangements
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