Bilingual (English/Spanish) Transitions of Care RN Case Manager

Devoted Health • Waltham, MA

9d • $85,000 - $100,000

About The Position

The Transitions of Care RN Case Manager provides telephonic, short-term, interdisciplinary care management during the 30 days after discharge for patients at high risk for readmission. The role advocates for patients by coordinating care and helping them access the resources and support needed to improve health outcomes. The ideal candidate is caring, compassionate, solution-oriented, committed to integrity and excellence, and able to adapt to a continuously evolving startup environment.

The RN engages newly discharged patients by phone, assesses their medical and psychosocial needs, and develops care plans with patients and caregivers. The role includes explaining medical information in plain language, educating patients about chronic conditions and warning signs, identifying barriers to care, and coordinating follow-up with clinicians, community resources, and other providers.

The position works Monday through Friday, either 10:00 a.m.–6:30 p.m. ET or 10:30 a.m.–7:00 p.m. ET. Candidates should be located in CT, MT, or PT time zones. The listed salary range is $85,000–$100,000 per year. The position is full-time; the company notes its total rewards package applies to full-time employees.

Requirements

• Unrestricted Compact RN license obtained in the United States, with ability to secure licensure in other states.
• 3–4 years of RN care management or telephonic case management experience.
• Fully bilingual in English and Spanish.

Nice To Haves

• Enthusiasm for spending meaningful time on the phone with patients and caregivers to build trust, educate, and coordinate care.
• Comfort and confidence working in an environment guided by performance and productivity metrics, with a focus on quality outcomes and patient experience.
• Health insurance experience, particularly Medicare Advantage.
• Prior Special Needs Plan, Population Health, or Transitions of Care case/care management experience.
• Clinical analytical thinking and ability to apply skills to individual patient needs.
• Telephonic care or case management experience.

Responsibilities

• Engage newly discharged patients telephonically to understand their needs, using technology and data tools.
• Assess comorbid conditions, emergency department and hospitalization history, medications, psychosocial factors, and patient values and preferences.
• Develop care plans with patients and caregivers, including problems, goals, and interventions, and continually evaluate patient progress.
• Explain complicated medical terms in plain language.
• Educate patients about chronic conditions, warning signs, plans for exacerbations, and barriers to care such as medication adherence.
• Respond to warning signs and provide active care management to close gaps in care.
• Partner with TOC Nurse Practitioners and Physicians to support smooth handoffs, follow-up, and coordinated post-discharge care.
• Refer patients to Devoted Medical when applicable and collaborate on patient care.
• Work with Devoted Community Guides to identify community-based organizations that can help patients meet their goals.
• Coordinate post-treatment care and durable medical equipment needs.
• Collaborate with primary care provider partners to coordinate evidence-based, effective, and accessible healthcare.

Benefits

• Employer-sponsored health, dental, and vision plans with low or no premium.
• Generous paid time off.
• $100 monthly mobile or internet stipend.
• Stock options for all employees.
• Bonus eligibility for roles below Director; Sales roles may be commission-eligible.
• Parental leave program.
• 401(k) program.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed