Rn Care Manager - Complex Care & Utilizer Management

Position: RN CARE MANAGER - COMPLEX CARE & HIGH UTILIZER MANAGEMENT
* 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.
* Facilitate and enable engagement with the CL provider and IDT
* Design and lead the implementation of care pathways and clinical protocols to streamline the management of the most common chronic illnesses.
* Develop and implement individualized chronic disease action plans to prevent avoidable ED visits, hospital readmissions, and disease exacerbations in collaboration with TOC and IDT.
* Conduct clinical reviews using evidence-based criteria to ensure appropriateness of care for chronic disease–related needs.
* Work closely with Center Light physicians, behavioral health teams, and external providers to ensure cohesive, risk reducing care coordination
* Maintain current knowledge of Center Light's provider network, including behavioral health and chronic disease specialties such as COPD, CHF, and Diabetes care.
* Communicate care trends, system changes, and clinical insights to the CMO and IDT.
* Serve as the Clinical Programs’ subject matter expert, coordinating with TOC, Social Work Care Managers, Clinical Review Specialists, and the IDT for high-risk or complex cases.
* Partner with TOC on safe discharge planning and transitions to reduce readmissions.
* Conduct prospective, concurrent, and retrospective clinical reviews related to chronic disease and complex care management.
* Apply evidence-based guidelines to determine medical necessity for participants with frequent ED visits, behavioral health complexity, or chronic disease complications.
* Participate in quality improvement initiatives, including inter‑rater reliability testing.
* Support HR‑HI provider panel updates and contribute clinical insights to enhance risk reduction and chronic disease control.
* Perform other duties as assigned.
* 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
* ** Standing** – Duration of up to 6 hours a day.
* ** Sitting/Stationary Positions** – Sedentary position in duration of up to 6-8 hours a day for consecutive hours/periods.
* ** Lifting/Push/Pull** – Up to 50 pounds of equipment, baggage, supplies, and other items used in the scope of the job using OSHA guidelines, etc.
* ** Bending/Squatting** – Have to be able to safely bend or squat to perform the essential functions under the scope of the job.
* ** Stairs/Steps/Walking/Climbing** – Must be able to safely maneuver stairs, climb up/down, and walk to access work areas.
* ** Agility/Fine Motor Skills** - Must demonstrate agility and fine motor skills to operate and activate equipment, devices, instruments, and tools to complete essential job functions (ie. typing, use of supplies, equipment, etc.)
* ** Sight/Visual Requirements** – Must be able to visually read documentation, papers, orders, signs, etc., and type/write documentation, etc. with accuracy.
* ** Audio Hearing and Motor Skills (Language) Requirements** – Must be able to listen attentively and document information from patients, community members, co-workers, clients, providers, etc., and intake information through audio processing with accuracy. In addition, they must be able to speak comfortably and clearly with language motor skills for customers to understand the individual.
* ** Cognitive Ability** – Must be able to demonstrate good decision-making, reasonableness, cognitive ability, rational processing, and analysis to satisfy essential functions of the job.
** Disclaimer:
** Responsibilities and tasks outlined in this job description are not exhaustive and may change as determined by the needs of the company.# C2Q Health Solutions offers management services tailored to the needs and goals of healthcare providers. Drawing from our leadership team's experience in providing key administrative solutions to healthcare programs such as managed long-term care, home care companies and other community health plans, C2Q’s expertise spans a full spectrum of functions that support an organization’s growth.
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