Care Manager (RN)

Position Title:

Care Manager RN

Work Location:

Remote - FL

Assignment Duration:

3 Months Potential to extend or conversion

Work Schedule:

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

Work Arrangement:

Remote

Position Summary:

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

Background & Context:

Maternity Care Management team supports our organization's Medicaid members across the maternal-child health continuum, from pregnancy through postpartum and infant care. The team provides care coordination, risk stratification, member outreach, education, behavioral health integration, social determinants of health (SDOH) support, NICU care management, First Year of Life (FYOL) services, and coordination with community and provider partners to improve maternal and infant health outcomes. The program focuses on reducing pregnancy complications, increasing prenatal and postpartum engagement, closing care gaps, and ensuring access to needed services and resources. This request is primarily driven by staffing changes, and ongoing operational needs within the Family Planning Services program. The team continues to support multiple lines of business and specialty programs, including high-risk maternity, postpartum care, Behavioral Health, SUD, and community-based initiatives. Additional support is needed to maintain member outreach, compliance requirements, care coordination activities related to maternal-child health initiatives and enhanced service offerings. The Family Planning Services team is a highly collaborative, mission-driven care management team focused on improving outcomes for the Start Smart for your Baby program pregnant members, postpartum members, infants, and families. The team works in a fast‑paced remote environment that emphasizes member advocacy, quality outcomes, compliance, teamwork, and cross‑functional collaboration with providers, community organizations, behavioral health partners, Healthy Start coalitions, and corporate stakeholders. This request is part of ongoing workforce planning to support staffing transitions, maintain operational stability, and ensure appropriate coverage across maternal-child health programs.

Key Responsibilities:

• Serves as the clinical lead for assigned members, focusing on maternal-child health and high-risk Medicaid populations.
• Reviews referrals and risk stratification reports.
• Conducts comprehensive Trimester based assessments.
• Develops and updates individualized care plans.
• Coordinates services with providers and community partners.
• Completes member outreach, addresses gaps in care, and documents interventions in the care management platform.
• Collaborates closely with physicians, hospitals, behavioral health providers, Healthy Start programs, community agencies, and internal interdisciplinary teams to improve member outcomes.
• Supports transitions of care, identifies social determinants of health needs, facilitates referrals, and ensures members receive appropriate services throughout pregnancy, postpartum, and other care management programs.
• 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.

Qualification & Experience:

Education and 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:

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

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

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