Nurse Care Manager, Virginia Medicaid

Job Summary:

The nurse care manager is responsible for coordination of appropriate, cost-effective services that enhance a members quality of life, focus on a members optimal level of independence, and reduces inappropriate utilization of medical services. The nurse care manager collaborates with members and the health care team to achieve evidence based clinical objectives and goals specific to preventative health measures and improved disease self-management.

Essential Responsibilities:

• In close collaboration with the member/members family, and members of the health care team, assesses the members health status, functional limitations, psychological status, social support systems, resources, environmental factors, and response to treatment.
• Uses motivational interviewing techniques to identify members readiness for change, creates appropriate care plan based on assessments, assists member with health system navigation and connection to community resources.
• Provides supportive counseling and education to members, families and caregivers, members of the health care team, and others including end-of-life issues and Advance Directives.
• Effectively manages and coordinates assigned caseload consistent with established criteria. Ensures consistent and reliable documentation of case management activities in compliance with all organization and department standards.
• Facilitates application process for accessing local, state, and federally funded programs (e.g., Medicaid, Medicare, Disability) and/or refers to appropriate community-based resources.
• Provides education and coaching to improve overall self-management, health, and wellness.
• Monitors chronic health conditions to achieve optimal self-management.

Basic Qualifications:

Experience

• Minimum two (2) years of experience in case management or three (3) years of clinical experience are required.

• For Virginia Medicaid: Minimum one (1) year of experience working directly with individuals who meet the Cardinal Care Priority Population criteria:

• Individuals involved with Child Protective Services, foster care, and/or former foster youth

• Individuals with Substance Use Disorder

• Youth with a mental health diagnosis

• Minimum one (1) year of experience working directly with individuals who meet the Cardinal Care Priority Population criteria (Individuals with Substance Use Disorder, Youth with a mental health diagnosis, Individuals involved with Child Protective Services, foster care, and/or former foster youth)

Education

• Associates degree in nursing required.

License, Certification, Registration

• This job requires credentials from multiple states. Credentials from the primary work state are required at hire. Additional Credentials from the secondary work state(s) are required post hire.
  
   

• Registered Nurse License (Maryland) within 6 months of hire AND Registered Nurse License (Virginia) within 6 months of hire

OR 

 

• Compact License: Registered Nurse within 6 months of hire

• Registered Nurse License (District of Columbia) within 6 months of hire
  
   

Additional Requirements:

• Must have reliable transportation and be able to complete in-person assessments in the home and community. (For anyone hired after April 1, 2025).
• Exceptional oral and written communication skills to interact with diverse members and providers and present care plan.
• Exceptional listening skills to assess needs and identify problems.
• Cultural humility to appreciate unique perspectives, backgrounds, and differences.

Preferred Qualifications:

• Case Manager Certificate (CCM) preferred.
• Pediatrics: Minimum one (1) year of recent experience with pediatric/adolescent population preferred.
• Perinatal: Minimum one (1) year of recent experience with recent labor and delivery of predominately high-risk obstetrics or perinatal population preferred.
• Renal: Minimum one (1) year of recent experience with nephrology or renal population preferred.
• Bachelors preferred.
• Virginia Medicaid requires one year experience working directly with individuals in Cardinal Care Priority populations