Clinical Case Manager, RN
About The Position
The Clinical Case Manager, RN at CareMore Health coordinates and manages quality, cost-effective care for members with complex medical and psychosocial needs. Working within an interdisciplinary care team, the 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 collaborates with providers, patients, families, and community partners to assess needs, develop individualized care plans, and facilitate services across the continuum of care. The role supports patients with chronic and complex conditions while ensuring appropriate utilization of healthcare resources.
Responsibilities
- Assess, plan, facilitate, coordinate, monitor, and evaluate services to meet members’ healthcare needs, particularly for those with complex or high-risk conditions.
- Develop and implement 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, and gaps in services.
- Analyze patient variances from established care plans and initiate interventions to resolve issues and improve outcomes.
- Support the value-based care model through improved outcomes, care coordination, and appropriate healthcare utilization.
- Manage high-risk or medically complex patients with chronic conditions such as heart failure, diabetes, and COPD.
- Collaborate with care teams to proactively manage patients at risk for hospitalization or complications.
- Promote preventive care, chronic disease management, and patient engagement strategies.
- 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 primary care, specialty care, hospitals, skilled nursing facilities, home health agencies, and community-based resources.
- Educate and support 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.
- Maintain accurate, complete, and timely documentation in accordance with organizational policies and regulatory requirements.
- Ensure compliance with clinical protocols, utilization management guidelines, and federal and state regulations.
- Maintain confidentiality of member information in accordance with HIPAA and other regulatory standards.
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What This Job Offers
Job Type
Full-time
Education Level
No Education Listed
