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Job Summary
The Care Manager—Registered Nurse is a key member of our Special Needs Plan (SNP) care team. The role involves coordinating care for members with multiple chronic medical and behavioral health conditions and various social determinants of health (SDoH) needs. Key responsibilities include conducting comprehensive assessments, addressing SDoH challenges by connecting members with resources, providing education and guidance, developing individualized care plans, monitoring progress, advocating for services, collaborating with the interdisciplinary team, and maintaining accurate documentation.
Key Responsibilities
50-75% of the day is dedicated to telephonic engagement with members and the coordination of their care.
Compile all available clinical information and partner with the member to develop an individualized care plan that encompasses goals and interventions.
Provide evidence-based disease management education and support to help the member achieve health goals.
Ensure the appropriate members of the interdisciplinary care team are involved.
Provide care coordination to support a seamless health care experience.
Maintain meticulous documentation of care management activity in the member’s electronic health record.
Collaborate with the Interdisciplinary Care Team to address barriers to care and develop strategies for maintaining the member’s stable health condition.
Identify and connect members with health plan benefits and community resources.
Meet regulatory requirements within specified timelines.
Support other members of the Care Team through clinical decision‑making and guidance as needed.
Assume additional responsibilities as assigned by leadership, including special projects, process improvement initiatives, or mentoring new team members.
Essential Competencies And Functions
Meet performance and productivity metrics, including call volume and regulatory requirements.
Conduct oneself with integrity, professionalism, and self‑direction.
Possess or be willing to learn the role of care management within Medicare and Medicaid managed care.
Be familiar with community resources and services.
Navigate and utilize various healthcare technology tools to enhance member care and maintain accurate records.
Maintain strong collaborative relationships with members and colleagues.
Communicate effectively, both verbally and in writing.
Exhibit excellent customer service and engagement skills.
Required Qualifications
Active and unrestricted Registered Nurse (RN) licensure in Georgia (GA) or a Compact RN license in the state of residence.
Proficient in Microsoft Office Suite: Word, Excel, Outlook, OneNote, and Teams.
Access to a private, dedicated workspace suitable for remote work.
Confidence working independently and using virtual collaboration tools.
3+ years of nursing experience.
2+ years of case management, discharge planning, and/or home healthcare coordination experience.
Preferred Qualifications
Experience providing care management for Medicare and/or Medicaid members.
Experience working with individuals with SDoH needs, chronic medical conditions, and/or behavioral health.
Experience conducting health‑related assessments and facilitating the care planning process.
Bilingual skills, especially English‑Spanish.
Education
Associate’s of Science in Nursing (ASN) degree (required).
Bachelor’s of Science in Nursing (BSN) (preferred).
License
Active and unrestricted Registered Nurse (RN) licensure in Georgia (GA) or a Compact RN license in the state of residence.
Anticipated Weekly Hours
40
Time Type
Full time
Pay Range
$54,095.00 - $116,760.00
Base hourly rate or base annual full‑time salary; additional bonuses, commissions and incentive programs may apply.
Great Benefits For Great People
Affordable medical plan options, 401(k) plan with company matching, and employee stock purchase plan.
Benefit solutions for paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access, and more (depending on eligibility).
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
We anticipate the application window for this opening will close on: 11/28/2025.