Care Manager (RN)

Title: Care Manager (RN)

Location: Remote - Florida

Duration: 03 Months - Possible extension or conversion

Monday - Friday 8am to 5pm No overtime required.

The Care Manager RN serves as the clinical lead for assigned members, focusing on maternal-child health and high-risk Medicaid populations.

Daily responsibilities:

Reviewing referrals and risk stratification reports, conducting comprehensive Trimester based assessments, developing and updating individualized care plans, coordinating services with providers and community partners, completing member outreach, addressing gaps in care, and documenting interventions in the care management platform.

Care Managers collaborate closely with physicians, hospitals, behavioral health providers, Healthy Start programs, community agencies, and internal interdisciplinary teams to improve member outcomes.

Care Managers are also responsible for supporting transitions of care, identifying social determinants of health needs, facilitating referrals, and ensuring members receive appropriate services throughout pregnancy, postpartum, and other care management programs.

The role supports key maternal-child health initiatives, including high-risk pregnancy management, postpartum engagement, First Year of Life (FYOL), behavioral health integration, and other population health programs designed to improve quality outcomes and reduce healthcare disparities.

Performance is measured through a combination of quality, productivity, compliance, and member engagement metrics, including:

• Timely acceptance and management of assigned referrals and cases.
• Completion of required assessments, care plans, and documentation within established timeframes.
• Adherence to outreach requirements and member engagement expectations.
• Successful closure or graduation of cases based on program goals and member outcomes.
• Care plan quality and interdisciplinary care team collaboration.
• Transition of Care (TOC) compliance and post-discharge follow-up completion.
• Regulatory, NCQA, state, and health plan documentation standards.
• Productivity and case management efficiency metrics tracked through organizational reporting and care management dashboards.

This role offers the opportunity to directly impact maternal and child health outcomes while working with some of the most vulnerable and complex Medicaid populations. Unlike traditional bedside nursing, the Care Manager RN functions as a clinical coordinator, advocate, educator, and population health strategist. The role combines clinical expertise, care coordination, behavioral health integration, social determinants of health interventions, and community partnership development.

The position provides exposure to innovative programs and initiatives focused on high-risk pregnancies, postpartum support, infant wellness, behavioral health integration, and health equity. Care Managers work independently in a remote environment while partnering with a multidisciplinary team committed to improving outcomes for members and families across the continuum of care.

This role is ideal for an RN who enjoys autonomy, critical thinking, relationship building, population health management, and making a measurable impact on maternal and infant health outcome

Candidate Requirements

Education/Certification
Required: 3 years of recent RN clinical experience.

5+ years of nursing experience with care management, case management, maternal-child health, OB, NICU, pediatrics, population health, Medicaid, managed care, or community health experience.
Preferred: Case Management experience

Licensure
Required: RN
Preferred: NA

Years of experience required: Minimum: 3 years of recent RN clinical experience.

5+ years of nursing experience with care management, case management, maternal-child health, OB, NICU, pediatrics, population health, Medicaid, managed care, or community health experience. Active, unrestricted RN license required

Disqualifiers:

No active RN license

Less than 3 years of nursing experience

No experience managing high risk OB member/populations or coordinating care across multiple disciplines

Inability to work independently in a remote environment

Limited computer proficiency or difficulty navigating multiple systems simultaneously

Poor documentation, time management, or organizational skills

No experience conducting telephonic member outreach and engagement (preferred for experienced candidates)

Additional qualities to look for:

Strong critical thinking and clinical assessment skills

Exceptional communication and motivational interviewing abilities

Ability to build rapport with diverse member populations

Highly organized and self-directed

Strong problem-solving skills

Ability to prioritize a large caseload and competing priorities

Passion for improving maternal and infant health outcomes

Experience collaborating with community resources, providers, hospitals, and interdisciplinary teams

Adaptability in a fast-paced and changing healthcare environment

Data-driven mindset with focus on quality outcomes and compliance

• Top 3 must-have hard skills stack-ranked by importance

1
Case Management and ability to conduct comprehensive assessments, identify risks, develop care plans, and coordinate interventions for complex members.

2
Experience managing a caseload, coordinating services across providers and community resources, addressing SDOH needs, and closing care gaps.

3
Proficiency documenting assessments and interventions, maintaining compliant records, and utilizing care management platforms, EMRs, and Microsoft Office applications.