Registered Nurse Care Manager Plus

Population Health, Follow up team

Full Time Exempt

40 hours/week

Days 8a-4:30pm

Remote

Summary

The RN Care Manager Plus, under the direction of the department Supervisor, is responsible for providing comprehensive, family-centered care management services to pediatric and young adult patients, including attributed managed care members, with complex medical, behavioral, and social needs. This role applies the nursing process (assessment, diagnosis/outcomes identification, planning, implementation, and evaluation) to ensure compliance with NCQA Complex Care Management (CCM) standards, promote interdisciplinary collaboration, improve population health outcomes, and reduce overall cost of care while maintaining high standards of clinical quality and patient experience. The RN Care Manager Plus partners with children and their caregivers to develop and coordinate individualized care plans that address physical needs, psychosocial and emotional factors, and social drivers of health.

Responsibilities

• Conducts comprehensive, trauma-informed assessments of pediatric and young adult patients, including medical, behavioral, developmental, and social drivers of health.
• Identifies high-risk and complex patients using stratification tools in alignment with NCQA Complex Care Management (CCM) criteria.
• Assesses caregiver capacity, health literacy, and barriers to care impacting outcomes.
• Analyzes assessment data to establish measurable, patient- and family-centered goals that align with quality and population health metrics.
• Develops individualized, evidence-based care plans addressing physical, behavioral, and social health needs while incorporating cultural and family preferences.
• Collaborates with interdisciplinary teams and community partners to coordinate preventive, chronic, transitional, and post-acute care services.
• Coordinates care across providers and settings, advocating for access to high-quality, cost-effective services.
• Provides education and coaching to patients and caregivers to support disease management, medication adherence, and self-care.
• Monitors healthcare utilization, treatment adherence, and caregiver engagement to identify intervention opportunities and reduce avoidable utilization.
• Participates in interdisciplinary care conferences to promote integrated care delivery and shared accountability for outcomes.
• Evaluates patient progress, revises care plans as needed, and supports successful program graduation and self-efficacy.
• Documents all assessments and interventions in compliance with organizational policies and regulatory standards (NCQA CCM, Joint Commission, ANA Code of Ethics), ensuring audit readiness and quality improvement.
• Other duties as required.

Other information:

Technical Expertise

• Knowledge of pediatric chronic conditions and developmental needs applied in through family-centered, trauma-informed, and culturally competent methodology.
• Strong clinical assessment, critical-thinking, and motivational interviewing skills with ability to manage and prioritize caseload effectively.
• Excellent communication and collaboration skills with a commitment to quality improvement and cost-effective care delivery.
• Proficiency in MS Office [Outlook, Excel, Word] or similar software is required. Epic software or similar EMR software is required.

Education and Experience

• Education: Bachelor of Science in Nursing from an accredited Nursing academic program is required.
• Licensure: C urrent, unrestricted MSL license as a Registered Nurse in Ohio is required; may be obtained within 90 days of hire.
• Certification: Current certification in Basic Life Support (BLS) from the American Heart Association is required. Certification from a nationally recognized care management and/or pediatric nursing organization is preferred.
• Years of relevant experience: Minimum 3 years of clinical experience in Nursing required. Experience in pediatric, ambulatory, care management and/or managed care is preferred.
• Basic Life Support (BLS) certification from the American Heart Association is required.
• Years of experience supervising: None.

Full Time

FTE: 1.000000

Status: Remote