What are the responsibilities and job description for the Hybrid High-Risk Case Manager position at Everly Talent?
A growing healthcare organization focused on delivering high-quality, patient-centered care management and utilization services across complex patient populations. This is an opportunity to join a collaborative clinical team dedicated to improving care coordination, reducing avoidable hospitalizations, and supporting high-risk members through intensive case management services.
The High Risk Nurse Case Manager provides intensive care management and coordination services for medically complex and high-utilization members who require enhanced intervention beyond traditional care management models. This role focuses on improving clinical outcomes, reducing avoidable readmissions, and supporting safe transitions of care across the healthcare continuum.
The Nurse Case Manager works closely with interdisciplinary teams, providers, facilities, caregivers, and community resources to develop and implement comprehensive, member-centered care plans for high-risk populations.
Key responsibilities include:
- Managing complex, high-risk member caseloads through intensive outreach and care coordination
- Coordinating transitions of care between hospitals, rehabilitation facilities, skilled nursing facilities, and home settings
- Conducting clinical assessments and identifying barriers impacting care and discharge planning
- Supporting medication reconciliation and post-discharge follow-up
- Coordinating referrals for home health, therapy, behavioral health, hospice, and community-based services
- Collaborating with providers, caregivers, and interdisciplinary teams to improve quality outcomes and reduce avoidable utilization
- Maintaining accurate documentation and participating in case conferences and care management initiatives
Qualifications:
- Active RN license required
- BSN preferred
- CCM or Case Management Certification preferred
- 4 years complex case management, or transitional care experience preferred
- Experience working with high-risk, geriatric, or medically complex populations preferred
- Knowledge of managed care, post-acute services, and care coordination processes
- Familiarity with InterQual, Milliman, NCQA, or URAC standards preferred
Compensation: 95k - 105k plus yearly bonus
Hours: Monday- Friday 8:30 - 5:30
Work Model: Hybrid (work from home 2 days per week after 60 days).