What are the responsibilities and job description for the Registered Nurse - Care Manager - Value Based Care - High-Risk Member Care Navigation position at Care Advantage Inc. Corporate?
Registered Nurse - Care Manager - Value Based Care - High-Risk Member Care Navigation
Location: Hybrid/Remote – Regular travel to Virginia
Make an Impact That Truly Matters
At Care Advantage, we believe healthcare is personal. As a Value‑Based Care RN Care Manager, you'll be at the heart of our mission-guiding high‑risk Medicaid members through complex care journeys, reducing avoidable hospitalizations, and improving lives through proactive, compassionate care.
This role is ideal for experienced RNs who thrive in relationship‑based care, population health, and collaborative clinical environments.
How You'll Live the ICARE Values Every Day
- Integrity: Advocate for members with clinical excellence, ethical judgment, and accountability
- Compassion: Deliver high‑touch, member‑centered care that respects each individual's unique needs
- Attitude: Bring positivity, resilience, and solutions‑focused thinking to every interaction
- Respect: Partner collaboratively with members, caregivers, providers, and health plan leaders
- Excellence: Drive measurable outcomes through data‑informed care management and continuous improvement
What You'll Do
High‑Risk Member Outreach & Care Navigation
- Serve as the central clinical point of contact for an assigned panel of high‑risk Medicaid VBC members
- Conduct proactive telephonic and in‑home outreach, monitoring health status and supporting care navigation
- Coordinate PCP visits, specialty care, DME, and community resources
- Review EMR and PointClickCare documentation to ensure informed, personalized outreach
- Identify and remove barriers to care, preventing unnecessary ED visits and hospitalizations
- Maintain timely, accurate documentation and ensure seamless follow‑up with Clinical and Operations teams
- Use population health tools to stratify risk and prioritize outreach efforts
Managed Care Organization (MCO) Collaboration
- Act as a clinical liaison with assigned Managed Care Organizations
- Participate in clinical rounding, presenting high‑risk member cases and aligned care strategies
- Prepare and maintain rounding materials, track outcomes, and drive follow‑through
- Share actionable insights from health plans with internal partners
- Support transparency and performance reporting aligned with plan requirements
Performance Management & Caregiver Education
- Partner with the VBC Performance team on health plan‑specific initiatives
- Design and deliver training for caregivers on:
- Chronic disease management (Diabetes, CHF, COPD)
- Medication adherence
- Early warning sign recognition
- Educate members and families to improve health literacy and self‑management
- Monitor trends, outcomes, and contractual performance measures
- Set and achieve quarterly goals in partnership with VBC leadership
What You Bring
- Active Registered Nurse (RN) license in applicable region
- 5 years of nursing experience (Value‑Based Care or population health strongly preferred)
- Experience with high‑risk member outreach and post‑discharge follow‑up
- Medicaid and MCO collaboration experience preferred
- Strong clinical leadership, communication, and care coordination skills
- Proficiency in Microsoft Office & Teams; PointClickCare experience a plus
Work Environment
- Field‑based role with regular travel; occasional overnight or weekend work
- Ability to sit, stand, bend, and lift up to 10 lbs
- Workplace accommodations available when appropriate
Why Care Advantage?
- Purpose‑driven work with measurable impact
- Collaborative, mission‑focused leadership
- Opportunity to shape and grow innovative Value‑Based Care programs
- A culture grounded in ICARE values, where clinicians are respected, supported, and empowered
Ready to Make a Difference?
If you're passionate about proactive care, value‑based outcomes, and building meaningful relationships-we'd love to meet you.
Apply today and help redefine care for those who need it most.
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