Community RM Care Mgr (RN Care Manager)

Job Description

Job DescriptionDescription:

The Community RN Care Manager manages high-risk, chronic-illness members to promote effective education, self-management support, and timely healthcare delivery, achieving optimal quality and financial outcomes. The Community RN Care Manager, in collaboration with the member and the interdisciplinary care team, will formulate and implement a care management plan that addresses the member's identified needs by assessing issues, resources, and care goals. The Community RN Care Manager will advocate for the member and support the member in navigating the health care system. HTA’s Care Management model provides longitudinal care management for identified members. A vital goal of the Community RN Care Manager is to manage the post-acute care of identified members to prevent or limit adverse health outcomes, frequent emergency room visits, and hospital readmissions. Based on the RN’s nursing experience and knowledge of the health care system, the aims are to provide members with education and resources to reduce preventable emergency room visits, hospitalizations, and readmissions

Requirements:

This position must be able to:

• Collaborates with providers and practice staff in identifying appropriate members for care management, utilizing established Care Management criteria.
• Performs initial and periodic holistic assessments for identified care-managed populations, including physical and psychosocial concerns for members as appropriate. The assessment consists of a systematic and pertinent collection of data on the member's health status. Prioritizes members according to intensity, need, and required follow-up.
• Formulate and implement a care management plan that addresses the member’s identified needs by assessing the member/family needs, issues, resources, and care goals; determining the choices available to individual members; and educating the patient/family on the choices available to meet their goals.
• Evaluate the effectiveness of the care plan in meeting established care goals; revise the plan as needed to reflect changing needs, issues, and goals. Monitor and evaluate the member's progress at prescribed minimal intervals.
• Collaborates with the healthcare team to revise the care management plan when changes occur. Initiates/participates in care conferences to discuss multidisciplinary team responsibilities, member progress, new problems, etc.
• Facilitates member access to community resources as appropriate in collaboration with Social Work to address identified SDOH needs.
• Promotes member self-management and empowers members/families to achieve maximum wellness and independence. Interacts professionally with members/families and involves them in the formation of a plan of care.
• Performs transitional follow-up calls for members recently discharged from acute hospitalizations, with particular emphasis on those members who are at high risk for readmission.
• Collaborates with providers and other healthcare team members, including inpatient facilities, outpatient providers, and the Utilization Management department, to initiate transitions of care and facilitate care across the healthcare continuum, and optimize clinical and financial outcomes.
• Determines and completes appropriate referrals to internal and external associates. Serves as a liaison to providers, members, and families to coordinate services.
• Participate in evening and weekend rotation for member transitional care needs.
• Maintains accurate and timely documentation. Ensures documentation meets current standards and policies.
• Strives to meet established standards for productivity.
• Participates in regular team meetings and peer review activities. Participates in departmental and organizational committees, as applicable. Assists/supports in the orientation of new personnel. Promotes collaborative teamwork.
• Performs all duties and responsibilities according to the Nurse Practice Act and the basic principles and guidelines of professional nursing.
• Maintains appropriate professional boundaries with members, families, coworkers, and community providers.
• Maintains a working knowledge of and adheres to applicable federal and state regulations, including, but not limited to, laws related to patient confidentiality, release of information, and HIPAA.
• Other duties as assigned

EDUCATION AND EXPERIENCE

Education:

• Associate Degree in Nursing

Required Experience:

• Two years of combined nursing-related care experience and/ or home care experience.

Preferred Experience:

• BSN or Advanced Degree in Nursing
• Case Management Certification desirable.
• Case Management, Care Management, Telephonic Case Management, and/or Disease Management experience

Other Requirements:

• Registered Nurse licensed in North Carolina or a Compact state.
• Current NC RN licensure in good standing
• Valid NC driver’s license
• Annual Flu Vaccine

KNOWLEDGE, SKILLS, AND ABILITIES

• Knowledge of care management concepts along the continuum, including principles of population health
• Knowledge of Medicare benefits
• Experience and ability to use Microsoft Office products and word-processing software daily.
• Excellent written, verbal, and listening communication abilities. Communicate appropriately and clearly to members, coworkers, and providers.
• Ability to manage conflict, stress, and multiple simultaneous work demands effectively and professionally.
• Ability to successfully articulate the process of attaining goals and outcomes of care management.
• Ability to apply clinical knowledge and experience in a care management role.
• Ability to engage and collaborate with the member and significant others in the care management process.
• Ability to care manage diverse populations without applying one’s values.
• Ability to work with minimal supervision within the nursing scope of practice.
• Ability to think critically and analytically, and work with minimal supervision.
• Ability to evaluate and appropriately respond to verbal and non-verbal communication from patients in diverse stages of development.
• Ability to use good judgment to protect personal safety while performing duties.

ABOUT HEATLTHTEAM ADVANTAGE

HealthTeam Advantage is an equal-opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, or disability status.

HealthTeam Advantage (HTA), a Greensboro-based health insurance company owned by Cone Health, offers Medicare Advantage plans to eligible Medicare beneficiaries in 33 North Carolina counties. HTA has been certified by Best Companies Group as one of America’s Best Workplaces in 2025. To learn more about HealthTeam Advantage, visit htanc.com.

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