Clinical - Care Manager (RN) - J01007

Job Profile Summary: Position Purpose: Develops, assesses, and facilitates complex care management activities for primarily physical needs members to provide high quality, cost-effective healthcare outcomes including personalized care plans and education for members and their families. Members enrolled in the Care Management program receive condition specific education, ongoing assessments of needs, identification of both short- and long-term goals, timely communication and collaboration between member and provider as well as the servicing providers when service coordination is needed.

Job Profile Summary:

Position Purpose:
Develops, assesses, and facilitates complex care management activities for primarily physical needs members to provide high quality, cost-effective healthcare outcomes including personalized care plans and education for members and their families.

Education/Experience:
Requires a Degree from an Accredited School of Nursing or a Bachelor's degree in Nursing and 2 4 years of related experience.

License/Certification:
RN - Registered Nurse - State Licensure and/or Compact State Licensure required

For YouthCare Illinois plan only: Bachelor s Degree and IL RN licensure required. Must reside in IL

For Sunshine Health (FL) Only: Employees supporting Florida's Children s Medical Services (CMS) must have a minimum of two years of pediatric experience. May require up to 80% local travel required

Responsibilities:
Evaluates the needs of the member, barriers to accessing the appropriate care, social determinants of health needs, focusing on what the member identifies as priority and recommends and/or facilitates the plan for the best outcome

Develops ongoing care plans / service plans and collaborates with providers to identify providers, specialists, and/or community resources to address member's unmet needs

Identifies problems/barriers to care and provide appropriate care management interventions

Coordinates as appropriate between the member and/or family/caregivers and the care provider team to ensure members are receiving adequate and appropriate person-centered care or services

Provides ongoing follow up and monitoring of member status, change in condition, and progress towards care plan / service plan goals; collaborate with member, caregivers, and appropriate providers to revise or update care plan / service plan as necessary to meet the member's goals / unmet needs

Provides resource support to members and care managers for local resources for various services (e.g., employment, housing, participant direction, independent living, justice, foster care) based on service assessment and plans, as appropriate

Facilitate care management and collaborate with appropriate providers or specialists to ensure member has timely access to needed care or services

May perform telephonic, digital, home and/or other site outreach to assess member needs and collaborate with resources

Collects, documents, and maintains all member information and care management activities to ensure compliance with current state, federal, and third-party payer regulators

Provides and/or facilitates education to members and their families/caregivers on disease processes, resolving care gaps, healthcare provider instructions, care options, referrals, and healthcare benefits

Provides feedback to leadership on opportunities to improve and enhance care and quality delivery for members in a cost-effective manner

Other duties or responsibilities as assigned by people leader to meet business needs
Performs other duties as assigned.

Complies with all policies and standards.

EEO:

Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans.

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Story Behind the Need
What is the purpose of this team? Describe the surrounding team (team culture, work environment, etc.) & key projects. Do you have any additional upcoming hiring needs, or is this request part of a larger hiring initiative?		Peach State services members with multiple high-cost medical, behavioral, and psycho-social needs. The goal of the Peach State Care Management Program is to assist members in achieving the highest possible level of wellness, functioning and quality of life. Members enrolled in the Care Management program receive condition specific education, ongoing assessments of needs, identification of both short- and long-term goals, timely communication and collaboration between member and provider as well as the servicing providers when service coordination is needed. The role of the Care Manager is to advocate on behalf of the member to ascertain quality, cost-effective services at the appropriate level of care and to ensure that the member has access to needed services at all times. This role of advocacy will assist the member in maximizing his/her potential and optimizing wellness. Team of Nurse Care Managers with one Care Coordinator for non-clinical support. Main goal is enrollment into our CM program for the high needs/high cost Medicaid members that are identified by various sources such as reports, discharge census, self-referrals, and providers.
Typical Day in the Role
Walk me through the day-to-day responsibilities and a description of the project (Outside of the Workday JD). What are performance expectations/metrics? What makes this role unique?		Walk me through the day to day responsibilities of this the role and a description of the project: Telephonic outreach both inbound and outbound to/from members. May need to call providers for coordination of care Must be able to use a computer for all documentation working in multiple systems & programs. Outbound calls to providers as needed to coordinate care for members. Provide health education and resources to members. Locate and provide community resources. Describe the performance expectations/metrics for this individual and their team: 20 or greater outreach attempts daily. 10 or greater new enrollments each week. Active Caseload of 73+ (after 120 days of employment) Timely documentation of interactions with members within 24hrs and sending appropriate letters and resources. Timely follow up with members at a minimum every 30 days at least 90% or greater of the time. Referrals appropriately to other team members (example- Social Work, Behavioral Health, Disease Management, Pharmacy, etc) What makes this role unique? Motivational interviewing and Engagement techniques for cold calls to members about enrollment in CM program. Telephonic Case Management with 100% computer-based documentation Discharge Planning with documentation computer based Medical Surgical Nursing with documentation computer based Home Health Nursing with documentation computer based Familiar with care for all ages from birth to adults Field/Face-to-face visits Cameras on during team meetings Outlook, Teams, Excel, Word, One drive, Webex phone
Candidate Requirements
Education/Certification	Required: Previous Telephonic CM Medical Surgical Nursing, minimum of 2-3 years Home Health (any amount of time) Comfortable working with all age groups from birth to adult			Preferred: CCM
Licensure	Required: Registered Nurse (Bachelors or Associates RN) Must be RN in GA or compact			Preferred: Bachelors
Years of experience required: 2-3 years telephonic CM, Medical Surgical Nursing/home health IN PERSON- minimum of 2-3 years Disqualifiers: Must live/reside in Georgia for this role, most recent position must be within the industry, will look at length of experience and gaps (please state if contractor role, please state why the gaps) Additional qualities to look for: NICU background
Top 3 must-have hard skills stack-ranked by importance		1	Computer efficiency using Outlook and Microsoft office (primarily Word and basic Excel, Teams chat)
		2	Telephonic experience with members for motivational interviewing and to gather assessment data
		3	Med/Surg & Home Health (ages birth to adult)
Candidate Review & Selection
Shortlisting process Candidate review & selection Interview information Onboard process and expectations		Projected Manager Candidate Review Date:			1-2 days post shortlisting
		Type of Interviews:			Teams CAMERA ON
		Required Testing or Assessment (by Vendor):			Agencies perform a computer literacy test attach as separate file - Outlook, Teams, Excel, Word, One drive
Next Steps
Do you have any upcoming PTO?		9/4/26, 9/7/26, 10/12/26, 10/30/26
Colleagues to cc/delegate		Hadi Zamrik