Registered Nurse - Care Manager - Value Based Care - High-Risk Member Care Navigation

Care Advantage Corporate • Richmond, VA

1d • Hybrid

About The Position

At Care Advantage, we believe healthcare is personal. As a Value‑Based Care RN Care Manager, you'll be at the heart of our mission-guiding high‑risk Medicaid members through complex care journeys, reducing avoidable hospitalizations, and improving lives through proactive, compassionate care. This role is ideal for experienced RNs who thrive in relationship‑based care, population health, and collaborative clinical environments.

Requirements

• Active Registered Nurse (RN) license in applicable region
• 5+ years of nursing experience
• Proficiency in Microsoft Office & Teams

Nice To Haves

• Value‑Based Care or population health experience strongly preferred
• Experience with high‑risk member outreach and post‑discharge follow‑up
• Medicaid and MCO collaboration experience preferred
• Strong clinical leadership, communication, and care coordination skills
• PointClickCare experience a plus

Responsibilities

• Serve as the central clinical point of contact for an assigned panel of high‑risk Medicaid VBC members
• Conduct proactive telephonic and in‑home outreach, monitoring health status and supporting care navigation
• Coordinate PCP visits, specialty care, DME, and community resources
• Review EMR and PointClickCare documentation to ensure informed, personalized outreach
• Identify and remove barriers to care, preventing unnecessary ED visits and hospitalizations
• Maintain timely, accurate documentation and ensure seamless follow‑up with Clinical and Operations teams
• Use population health tools to stratify risk and prioritize outreach efforts
• Act as a clinical liaison with assigned Managed Care Organizations
• Participate in clinical rounding, presenting high‑risk member cases and aligned care strategies
• Prepare and maintain rounding materials, track outcomes, and drive follow‑through
• Share actionable insights from health plans with internal partners
• Support transparency and performance reporting aligned with plan requirements
• Partner with the VBC Performance team on health plan‑specific initiatives
• Design and deliver training for caregivers on: Chronic disease management (Diabetes, CHF, COPD), Medication adherence, Early warning sign recognition
• Educate members and families to improve health literacy and self‑management
• Monitor trends, outcomes, and contractual performance measures
• Set and achieve quarterly goals in partnership with VBC leadership

Benefits

• Regular travel to Virginia
• Workplace accommodations available when appropriate
• Purpose-driven work with measurable impact
• Collaborative, mission-focused leadership
• Opportunity to shape and grow innovative Value‑Based Care programs
• A culture grounded in ICARE values, where clinicians are respected, supported, and empowered

What This Job Offers

• Job Type: Full-time
• Career Level: Senior