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Case Management Nurse

Medix

Are you a passionate RN looking to make a meaningful impact with high-acuity patients? Join a leading health plan team where you’ll manage complex cases, advocate for vulnerable populations, and work within nationally recognized quality standards. Overview of the Role In this role, you will manage a complex population of patients with chronic conditions such as Diabetes, Hypertension, and COPD . You’ll play a critical role in improving outcomes through ongoing engagement, care coordination, and clinical oversight. What You’ll Do: Manage a caseload of up to 45 members Conduct telephonic clinical assessments and follow-ups post-discharge Maintain bi-weekly patient touchpoints Perform detailed, audit-ready documentation aligned with NCQA standards Develop and execute individualized care plans Lead complex case management for high-risk populations Coordinate care across medical, behavioral, and social services Act as a patient advocate to ensure access to essential healthcare resources Collaborate with hospital teams on discharge planning and transitions of care Identify gaps in services and implement solutions Monitor utilization, quality, and compliance (including fraud, waste, and abuse) Participate in interdisciplinary meetings, quality initiatives, and community outreach Maintain accurate and timely documentation in clinical systems ✅ Required Qualifications Active DC RN License (required upon hire) Minimum 2+ years of nursing experience 1–2 years of case management experience Experience working with high-acuity or frequently hospitalized patients Familiarity with NCQA standards and guidelines Monday–Friday, 8:00 AM – 5:00 PM Hybrid: 4 days onsite, 1 day remote This is more than a case management role—you’ll serve as a true advocate , helping patients overcome barriers and navigate complex healthcare systems while delivering measurable outcomes through meaningful engagement. If you're ready to elevate your nursing career and make a real impact, apply today or message me directly to learn more. #J-18808-Ljbffr

Vacancy posted 3 days ago
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