Job Description Summary

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The Clinical Case Manager, RN at CareMore Health is responsible for coordinating and managing quality, cost-effective care for members with complex medical and psychosocial needs. Working within an interdisciplinary care team, this role supports CareMore’s value-based care model by proactively managing high-risk patient populations, improving clinical outcomes, and helping reduce avoidable hospitalizations and emergency department utilization.
The Clinical Case Manager, RN collaborates closely with providers, patients, families, and community partners to assess needs, develop individualized care plans, and facilitate services across the continuum of care. This role plays a critical part in supporting patients with chronic and complex conditions while ensuring appropriate utilization of healthcare resources.

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How will you make an impact & Requirements

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Key Responsibilities

Clinical Case Management

• Assess, plan, facilitate, coordinate, monitor, and evaluate services to meet the healthcare needs of members, particularly those with complex or high-risk conditions.

• Develop and implement comprehensive clinical case management plans tailored to each patient’s medical, behavioral, and social needs.

• Collaborate with physicians, advanced practice providers, and interdisciplinary care teams to support evidence-based care and effective disease management.

• Monitor patient progress and revise care plans as needed to address changes in clinical status or care needs.

• Identify and address barriers to care including social determinants of health, treatment adherence challenges, or gaps in services.

• Analyze patient variances from the established care plan and initiate appropriate interventions to resolve issues and improve outcomes.

Value-Based Care & Population Health Management

• Support CareMore’s value-based care model by focusing on improved outcomes, care coordination, and appropriate utilization of healthcare services.

• Manage high-risk or medically complex patients with chronic conditions such as heart failure, diabetes, COPD, and other conditions requiring ongoing care coordination.

• Collaborate with care teams to proactively manage patients who are at risk for hospitalization or complications.

• Promote preventive care, chronic disease management, and patient engagement strategies that improve long-term health outcomes.

Care Coordination & Member Support

• Support members and their representatives regarding care needs, care transitions, and changes in health status.

• Serve as a liaison between patients, providers, and care teams to facilitate coordinated care delivery.

• Coordinate services across multiple care settings including primary care, specialty care, hospitals, skilled nursing facilities, home health agencies, and community-based resources.

• Provide education and support to patients and families regarding treatment plans, medications, and self-management strategies.

• Support smooth transitions between care settings to reduce complications, readmissions, and unnecessary healthcare utilization.

Documentation & Compliance

• Maintain accurate, complete, and timely documentation in accordance with organizational policies and regulatory requirements.

• Ensure compliance with applicable clinical protocols, utilization management guidelines, and federal and state regulations.

• Maintain strict confidentiality of member information in accordance with HIPAA and other regulatory standards.

Qualifications (Required)

• Current, unrestricted Registered Nurse (RN) license in the applicable state(s)

• Minimum 2 years of clinical experience in nursing, case management, care coordination, or utilization review

• Experience working with complex, chronically ill, or high-risk patient populations preferred

• Knowledge of care coordination, discharge planning, utilization management, and population health strategies

• Strong clinical assessment, communication, and organizational skills

• Satisfactory completion of required health screenings including TB testing (must be within the last 12 months)

• Hep B vaccinations (all 3, titer or signed declination)

Core Competencies

Clinical Assessment & Judgment
Applies strong clinical knowledge and critical thinking skills to assess patient needs and coordinate appropriate care.

Population Health Management
Supports management of high-risk populations through proactive care coordination and chronic disease management.

Value-Based Care Focus
Promotes care strategies that improve outcomes, enhance patient experience, and support responsible stewardship of healthcare resources.

Care Coordination
Effectively coordinates services across providers, facilities, and community partners to ensure continuity of care.

Patient-Centered Communication
Communicates clearly and compassionately with patients, families, and care teams.

Collaboration & Teamwork
Works effectively within interdisciplinary care teams to support integrated patient care.

Problem Solving
Identifies barriers to care and develops practical solutions to improve patient outcomes.

 

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Compensation:

$38.97

to

$58.47