What are the responsibilities and job description for the Registered Nurse Case Manager position at Infusion IV Therapy?
Here’s a professional Job Description for a Nurse Case Manager (Medicaid Population) tailored to regulatory compliance and care coordination requirements:
Job Title: Nurse Case Manager – Medicaid Population
Position Summary:
The Nurse Case Manager is responsible for providing comprehensive care coordination, clinical assessment, and ongoing case management for Medicaid members with complex medical, behavioral health, and social needs. The role ensures compliance with federal and state Medicaid regulations, promotes appropriate utilization of healthcare services, and supports improved health outcomes through patient-centered, community-based care coordination.
Key Responsibilities:Clinical Case Management
- Conduct comprehensive health assessments of Medicaid members, including physical, behavioral, and social determinants of health
- Develop, implement, and regularly update individualized care plans based on member needs and clinical guidelines
- Coordinate medical, behavioral health, pharmacy, and community-based services
- Monitor member progress and adjust care plans as clinically indicated
Care Coordination
- Collaborate with primary care providers, specialists, hospitals, home health agencies, and community resources
- Facilitate transitions of care (e.g., hospital discharge planning, skilled nursing facility coordination)
- Ensure timely follow-up after emergency department visits or inpatient admissions
- Assist members in accessing durable medical equipment, transportation, and home support services
Regulatory & Medicaid Compliance
- Ensure all case management activities comply with state Medicaid regulations, managed care organization (MCO) requirements, and federal guidelines
- Maintain accurate, timely, and complete documentation in the electronic health record (EHR) and care management systems
- Participate in audits, quality assurance reviews, and performance improvement initiatives
- Adhere to HIPAA and all confidentiality requirements
Patient Advocacy & Education
- Educate members and caregivers on chronic disease management, medication adherence, and preventive care
- Advocate for medically necessary services and appropriate levels of care
- Support members in overcoming barriers to care, including housing, transportation, and financial limitations
Utilization Management Support
- Identify high-risk members and proactively intervene to reduce avoidable hospitalizations and emergency room utilization
- Review service utilization patterns and coordinate with utilization management teams as needed
Qualifications:
- Active and unrestricted Registered Nurse (RN) license in the state of practice
- Bachelor of Science in Nursing (BSN) preferred (or equivalent experience)
- Minimum 2–3 years of clinical experience in case management, care coordination, home health, or acute care
- Experience working with Medicaid populations or managed care organizations preferred
Knowledge, Skills, and Abilities:
- Strong understanding of Medicaid programs, managed care models, and healthcare regulations
- Knowledge of chronic disease management, behavioral health integration, and social determinants of health
- Excellent communication, documentation, and organizational skills
- Ability to work independently and manage a high-volume caseload
- Proficiency in electronic medical records (EMR/EHR) systems
Core Competencies:
- Patient-centered care
- Clinical judgment and critical thinking
- Care coordination and interdisciplinary collaboration
- Cultural competency and health equity awareness
- Regulatory compliance and ethical practice
Work Environment:
- Standard office hours with occasional flexibility required for urgent care coordination needs
Pay: $30.00 - $38.00 per hour
Work Location: Hybrid remote in Greeley, CO 80634
Salary : $30 - $38