Care Manager I

Capital Health Plan • Tallahassee, FL

2d

About The Position

We are seeking a Care Manager I to support Capital Health Plan members across hospital and skilled nursing settings, along with coordinating Emergency Room follow-up. This role is responsible for reviewing and managing clinical care, ensuring members receive care at the most appropriate level, and facilitating smooth transitions between care settings. The Care Manager I works closely with members, families, providers, Medical Directors, and interdisciplinary care teams to support admission reviews, concurrent reviews, discharge planning, and follow‑up services. This position plays a critical role in achieving optimal clinical outcomes while aligning care delivery with regulatory guidelines, quality standards, and organizational resources.

Requirements

• Associate's degree from an accredited college or technical school, or equivalent education and experience
• Minimum of one year of related clinical or care coordination experience preferred
• Licensed medical professional in the State of Florida
• Experience monitoring inpatient, skilled nursing, or home health care services
• Strong clinical judgement and decision-making skills related to level-of-care determinations
• Ability to gather, prepare, and present clinical and benefit information for Utilization Management review
• Strong written and verbal communication skills for coordination with members, families, providers, and care teams
• Proficiency using electronic medical records and documentation systems
• Experience coordinating post Emergency Room follow-up to support safe transitions of care

Nice To Haves

• Experience with discharge planning, transitions of care, or home health coordination
• Experience conducting admission and concurrent reviews
• Familiarity with CMS, state, and regulatory requirements related to care management
• Knowledge of quality improvement and patient safety reporting processes
• Coding experience or familiarity with medical necessity criteria
• Strong proficiency with Microsoft Office applications (Word, Excel, Outlook)

Responsibilities

• Reviewing and managing clinical care
• Ensuring members receive care at the most appropriate level
• Facilitating smooth transitions between care settings
• Working closely with members, families, providers, Medical Directors, and interdisciplinary care teams to support admission reviews, concurrent reviews, discharge planning, and follow‑up services
• Achieving optimal clinical outcomes while aligning care delivery with regulatory guidelines, quality standards, and organizational resources

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: Associate degree
• Number of Employees: 101-250 employees