RN Care Manager – Complex Care & High Utilizer Management

Responsibilities

• Deliver ongoing care, support, and health education to participants with chronic illnesses including COPD, Diabetes, Heart Failure, cardiovascular disease, and degenerative neurological or musculoskeletal disorders.
• Collaborate closely with medical providers, behavioral health specialists, and operational leaders to develop and implement strategies that reduce avoidable utilization.
• Conduct clinical reviews using evidence-based criteria to ensure appropriateness of care for chronic disease‑related needs.
• Monitor utilization patterns and proactively engage participants to reduce unnecessary, repetitive, or avoidable service use.
• Support participants in navigating the healthcare system and reinforce chronic‑condition self‑management practices.

Qualifications

• BSN required
• Current Registered Nurse (RN) license in New York State
• Certification in Case Management (CCM) or equivalent, preferred
• 3+ years of clinical experience in chronic disease management, care coordination, or case management
• Experience working with high‑risk, medically complex, or high‑utilizing populations
• Strong assessment, communication, and interdisciplinary collaboration skills
• Experience in PACE, MLTC, Managed Care, or high‑risk care management preferred
• Prior experience with behavioral health integration or complex psychosocial case management preferred