Care Manager I

Overview F/T or P/T status: Full-time We are seeking a Care Manager I to support Capital Health Plan members across hospital and skilled nursing settings, along with coordinating Emergency Room follow-up. This role is responsible for reviewing and managing clinical care, ensuring members receive care at the most appropriate level, and facilitating smooth transitions between care settings. The Care Manager I works closely with members, families, providers, Medical Directors, and interdisciplinary care teams to support admission reviews, concurrent reviews, discharge planning, and follow‑up services. This position plays a critical role in achieving optimal clinical outcomes while aligning care delivery with regulatory guidelines, quality standards, and organizational resources. Responsibilities Key responsibilities include: Support admission reviews, concurrent reviews, discharge planning, and follow‑up services for CHP members. Review and manage clinical care to ensure appropriate level of care and smooth transitions between settings. Collaborate with members, families, providers, Medical Directors, and care teams to optimize outcomes while meeting regulatory and quality standards. Coordinate Emergency Room follow-up to support safe transitions of care. Qualifications Required: Associate's degree from an accredited college or technical school, or equivalent education and experience Minimum of one year of related clinical or care coordination experience preferred Licensed medical professional in the State of Florida Experience monitoring inpatient, skilled nursing, or home health care services Strong clinical judgement and decision-making skills related to level-of-care determinations Ability to gather, prepare, and present clinical and benefit information for Utilization Management review Strong written and verbal communication skills for coordination with members, families, providers, and care teams Proficiency using electronic medical records and documentation systems Experience coordinating post-Emergency Room follow-up to support safe transitions of care Highly preferred candidates also have: Experience with discharge planning, transitions of care, or home health coordination Experience conducting admission and concurrent reviews Familiarity with CMS, state, and regulatory requirements related to care management Knowledge of quality improvement and patient safety reporting processes Coding experience or familiarity with medical necessity criteria Strong proficiency with Microsoft Office applications (Word, Excel, Outlook) About Capital Health Plan (CHP) CHP is a locally based, not-for-profit health maintenance organization serving the Tallahassee region for more than four decades. Founded by community leaders with a mission to deliver high-quality, affordable, and patient-centered health care, CHP has grown into a nationally recognized healthcare organization while remaining deeply rooted in the communities it serves. CHP is proud to be an Equal Opportunity Employer and is committed to maintaining a workplace that values professionalism, integrity, and respect. We provide equal employment opportunities to all employees and applicants and do not discriminate on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, veteran status, or any other legally protected status. #J-18808-Ljbffr