Complex Case Manager RN in United States at Jobgether

This position is posted by Jobgether on behalf of a partner company. We are currently looking for a Complex Case Manager RN in the United States.

This role offers an opportunity to make a meaningful impact by supporting members with complex healthcare needs through personalized case management and care coordination. Working within a collaborative, multidisciplinary environment, you will help improve clinical outcomes, remove barriers to care, and guide members toward healthier lifestyles and long-term wellness goals. The position combines clinical expertise with analytical thinking, allowing you to assess healthcare needs, develop tailored care plans, and connect members with the right resources and interventions. You will play a key role in improving quality, financial, and functional outcomes while working in a flexible, remote-friendly setting. This is an excellent opportunity for an experienced RN who thrives in a fast-paced environment and is passionate about patient advocacy, care coordination, and population health management.

• Manage a designated panel of members by assessing healthcare needs and identifying appropriate clinical interventions and support resources.
• Develop and maintain individualized care plans that include both short- and long-term goals, regular follow-ups, and strategies to improve health outcomes.
• Conduct proactive outreach to members enrolled in case management programs, providing education, support, and care coordination.
• Identify and address barriers to care while connecting members with community resources and healthcare services.
• Monitor and improve clinical, financial, and functional outcomes for assigned members.
• Maintain accurate and timely documentation while ensuring compliance with regulatory standards, accreditation requirements, and organizational policies.
• Collaborate with multidisciplinary teams to ensure members receive comprehensive and coordinated care.
• Stay informed on current case management standards, healthcare regulations, and best practices.

• Current RN licensure in Pennsylvania, a multistate eNLC license, or active RN licensure in WV, DE, or NY, with the ability to obtain additional licenses if required.
• Minimum of 7 years of combined experience in clinical care, case management, disease management, provider operations, or health insurance environments.
• Strong understanding of disease processes, healthcare systems, and care coordination practices.
• Excellent communication, negotiation, and interpersonal skills with the ability to positively influence and support members.
• Proficiency in Microsoft Excel and strong analytical skills with the ability to interpret clinical and financial data.
• Ability to manage multiple priorities in a fast-paced, high-performing environment while working independently with moderate supervision.
• Experience working with diverse populations and applying culturally competent care practices is highly valued.
• Bachelor’s degree in Nursing and Case Management certification are preferred.
• Additional experience in motivational interviewing, CBT, or DBT is considered a strong asset.

• Competitive salary range of $72,700 – $116,600 annually
• Remote work flexibility with minimal travel requirements
• Comprehensive healthcare coverage and wellness support
• Opportunities for professional growth and career advancement
• Collaborative and mission-driven team environment
• Exposure to multidisciplinary healthcare initiatives and population health programs
• Supportive culture focused on quality outcomes and patient advocacy
• Inclusive workplace committed to equal opportunity and accessibility