Nurse Case Manager, RN

Position Summary: The Case Manager is responsible for engaging members enrolled in case management programs to provide comprehensive care coordination, patient education, and individualized care planning. The goal of this role is to support improved health outcomes, enhance patient experience, and ensure appropriate utilization of healthcare services across the continuum of care.

 

The Case Manager works collaboratively with members, caregivers, physicians, and interdisciplinary care teams to assess needs, identify barriers to care, and develop actionable plans of care that promote optimal health, safety, and wellness.

 

Essential Position Functions/Responsibilities:

• Provides telephonic and/or virtual case management services to assigned members, ensuring timely outreach, engagement, and ongoing follow-up.
• Coordinates, plans, implements, and evaluates case management activities to support members’ medical, behavioral, and psychosocial needs.
• Conducts comprehensive assessments to identify member needs, risks, barriers, and opportunities for intervention.
• Develops individualized, goal-oriented care plans in collaboration with members, caregivers, physicians, and interdisciplinary team members.
• Implements care coordination strategies to support chronic disease management, preventive care, and appropriate utilization of healthcare services.
• Monitors and evaluates care plans on an ongoing basis, revising interventions as needed to achieve optimal outcomes.
• Establishes appropriate follow-up intervals, case closure criteria, and referral pathways based on member acuity and needs.
• Applies clinical judgment to identify root causes of hospitalization and supports interventions to reduce avoidable readmissions.
• Ensures consistent application of evidence-based guidelines, clinical protocols, and regulatory requirements in all case management activities.
• Identifies and addresses barriers to care, including social determinants of health, access issues, and compliance challenges.
• Facilitates interdisciplinary care team (ICT) meetings and collaborates with internal and external providers to support coordinated care delivery.
• Presents complex cases in collaborative rounds to obtain multidisciplinary input and optimize care outcomes.
• Utilizes motivational interviewing techniques to educate, engage, and support members in behavior change and self-management.
• Ensures adherence to organizational policies, procedures, and regulatory standards at all times.
• Documents all case management activities accurately, thoroughly, and in a timely manner in accordance with organizational standards.
• Applies critical thinking, clinical judgment, and problem-solving skills to complex case scenarios.
• Maintains current knowledge of case management standards, regulatory requirements, and best practices.
• Serves as a resource to team members and supports a culture of collaboration, accountability, and continuous improvement.
• Promotes organizational policies, procedures, and care management initiatives while supporting process improvement efforts.
• Performs other related duties as assigned.

 

Qualification Requirements:

Skills, Knowledge, Abilities

 

• Strong understanding and practical application of MCG Guidelines.
• Knowledge of NCQA standards, as well as Federal and State regulatory requirements related to care management.
• Strong clinical assessment, care coordination, and discharge planning skills.
• Excellent verbal and written communication skills with ability to communicate clearly and professionally with diverse populations.
• Strong interpersonal skills with ability to collaborate effectively with interdisciplinary teams, patients, families, and external providers.
• Excellent organizational, prioritization, and time management skills.
• Strong analytical thinking, clinical judgment, and problem-solving abilities.
• Ability to work independently while managing multiple priorities in a fast-paced environment.
• Proficiency in documentation standards and care management systems.
• Demonstrated ability to use motivational interviewing and patient engagement strategies effectively.
• Knowledge of utilization management principles and transitions of care processes.

 

 

Training/Education:

• Current New York State Registered Nurse (RN) license required.
• Bachelor of Science in Nursing (BSN) preferred.
• Strong foundation in clinical assessment and care coordination principles.
• Training in case management, discharge planning, or utilization management strongly preferred.

 

Experience:

• Minimum 3–5 years of clinical experience in an acute care setting required.
• Prior experience in utilization management, case management, or care coordination strongly preferred.
• Experience in discharge planning and transitions of care preferred.
• Demonstrated experience in patient and family education.
• Experience working with interdisciplinary teams in a healthcare or managed care environment preferred.

Equal Employment Opportunity Statement:
HealthCare Partners, MSO is committed to fostering a diverse and inclusive workplace. We provide equal employment opportunities (EEO) to all employees and applicants without regard to race, color, religion, sex, national origin, age, disability, genetics, or any other protected status under federal, state, or local laws. In compliance with all applicable laws, HealthCare Partners, MSO upholds a strict non-discrimination policy in every location where we operate. This policy applies to all aspects of employment, including but not limited to recruitment, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.

Job Disclaimer:
The above job description outlines the general scope and responsibilities of the position. It is not intended to be an exhaustive list of duties, skills, or qualifications required. Responsibilities may evolve based on business needs.