RN Case Manager

We are seeking a RN Case Manager to join our team. RN Case Manager Turnagain Community Health (TCH) Schedule: 20–30 hours per week Work location: Remote, with periodic on-site attendance required Position Overview The RN Case Manager is an integral member of TCH’s interdisciplinary care team, helping patients access services and navigate the healthcare system. This role coordinates specialty referrals, supports self-care management, connects patients with community resources, and collaborates with outside providers to ensure seamless transitions of care. Working within a primary care medical home, the RN Case Manager partners with patients, families, and the healthcare team to promote timely access, comprehensive care, continuity of services, and patient well-being through a trauma-informed approach. Essential Duties and Responsibilities Coordinate with specialists, hospitals, labor and delivery departments, emergency departments, and other healthcare facilities to ensure continuity of care. Manage follow-up for specialty referrals and clinically indicated services outside TCH, including: Housing and transportation assistance Vocational rehabilitation Specialized mental health care and substance use treatment Home health and hospice care Coordinate services based on each patient’s individual needs. Communicate information from the healthcare team to patients as needed. Patient Education and Self-Care Support Use motivational interviewing to help high-risk patients identify self-management goals and develop care plans. Educate patients about healthy lifestyle practices and management of acute and chronic conditions. Conduct risk assessments for identified populations, including HIV and obstetric patients, and discuss strategies to reduce identified risks. Help patients understand TCH’s care team resources and processes that affect their care. Patient Monitoring and Follow-Up Track treatment response and monitor patients in person or by telephone for changes in symptoms, treatment side effects, or complications. Track follow-up and clinical outcomes, document encounters in the patient registry, and use the system to identify and re-engage patients. Follow up with high-risk patients who miss appointments to identify barriers and develop a plan to address them. Consult with medical providers to facilitate treatment plan changes for patients who are not improving or who may need more intensive or specialized care. Resource Access and Barrier Reduction Identify relevant community resources and help patients access available services. Assist patients with obtaining durable medical equipment, medications, and other care-related items when resources are limited. Collaborate with outside service providers to support coordinated care and smooth transitions between services. Nursing, Teamwork, and Quality Improvement Participate as a member of the interdisciplinary healthcare team. Collaborate with the clinical QA/QI director to collect data and conduct quality improvement activities for specific patient populations. Qualifications Required Post-secondary education in nursing. Current, active Alaska Registered Nurse license in good standing. Current CPR certification. At least three years of nursing experience. Two to three years of leadership experience. Preferred Community Health Center experience. Remote Work and On-Site Requirements This position may be performed remotely from a location approved by TCH. Preference may be given to candidates located in Alaska. Remote work locations are considered on a case-by-case basis and must be approved by TCH before employment. Periodic on-site attendance is required for meetings, training, program activities, community events, and other operational needs. Retirement: 401(k) with employer matching Health coverage: Health, dental, and vision insurance Additional coverage: Life and disability insurance Time off: Paid time off #J-18808-Ljbffr