Case Management RN (68014)

“Sanitas is a global healthcare organization expanding across the United States. Our services include primary care, urgent care, nutrition, lab, diagnostic, health care education and resources for our patients. We strive to attract professionals who believe in our mission, vision and are dedicated to the service of our patients and their families creating a memorable experience through compassion, respect, and kindness.”

Job Summary

The Case Management RN manages the transition of care for members post-discharge and those with chronic conditions, coordinating follow-up care, creating personalized care plans, and educating patients and caregivers, to prevent hospital readmissions, reduce over-utilization, and improve overall health outcomes.

Essential Job Functions

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. 

• Conduct timely post-discharge outreach (within 24-72 hours), reviewing discharge summaries, medication lists, and follow-up recommendations, to assess member needs, confirm understanding of medical instructions, and identify immediate gaps in care.
• Coordinate follow-up appointments and post-acute services, collaborating with primary care providers, specialists, home health agencies, and community resources, to ensure seamless continuity of care across the continuum.
• Develop and implement individualized care plans based on assigned program categories, identifying early signs of complications or risk factors, to manage chronic conditions effectively and escalate clinical issues appropriately.
• Educate members and caregivers using motivational interviewing techniques, providing guidance on red-flag symptoms and self-management strategies, to empower patients and reduce patterns of over-utilization (e.g., frequent ED visits).
• Document all interactions, assessments, and clinical interventions in the care management platform accurately and timely, to maintain compliance with organizational policies, advocate for member needs, and ensure alignment with clinical guidelines.

Supervisory Responsibilities

This position currently has no supervisory responsibilities.

Required Education

Degree in Nursing (ASN or BSN), Social Work (BSW or MSW).

Required Experience

Proven experience in clinical case management, care coordination, utilization review, or population health management within a healthcare setting.

Required Licenses and Certifications

Active, unrestricted clinical license as a Registered Nurse (RN), Licensed Practical Nurse (LPN), Clinical Social Worker.

Required Knowledge, Skills, and Abilities

• Clinical Knowledge: Strong, demonstrated understanding of chronic disease management, evidence-based medical guidelines, and post-acute care processes.
• Patient Engagement: Proficiency in motivational interviewing techniques to effectively educate and empower members and their caregivers.
• Communication: Excellent verbal and written communication skills to interact effectively with patients, interdisciplinary care teams, and community partners.
• Problem-Solving: Strong critical thinking and clinical problem-solving skills to identify barriers to care, risk factors for readmission, and appropriate transition plans.
• Technical Skills: Ability to accurately and timely document assessments and interventions in care management platforms or Electronic Medical Records (EMR).

Preferred Qualifications

• Certified Case Manager (CCM) credential or similar certification in care coordination/utilization review.
• Bilingual (English and Spanish) to effectively serve diverse member populations.

Financial Responsibilities

This position currently has no financial responsibilities.

Budget Responsibilities

This position currently has no budget responsibilities.

Languages

• Advanced English is required.
• Bilingual Spanish/Creole is preferred.

Travel

This position does not currently require travel.

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. 

While performing the duties of this job the employee is regularly required to work standing up, walk, use hands to operate tools and equipment and must be able to exert regularly up to 10 pounds of force, frequently exert 30 pounds of force and occasionally exert 50 pounds of force to constantly perform the essential job functions. The employee will be frequently required to reach with hands and arms, bend, balance, kneel, crouch, crawl, push, and pull. Specific vision abilities required by this job include close vision, distance vision, peripheral vision, depth perception and ability to adjust focus.

Environmental Conditions

Inside: The employee is subject to environmental conditions, protection from weather conditions but not necessarily from temperature changes. The worker is subject to noise; there may be sufficient noise to cause the worker to shout in order to be heard above ambient noise level.

Physical/Environmental Activities

Please confirm for the following questions if these working conditions are encountered Occasionally (1-33% of time on the job), Frequently (34-66% of time on the job), Constantly (67-100% of time on the job), or Not Applicable N/A

• Must be able to travel to multiple locations for work (i.e. travel to attend meetings, events, conferences). Not Applicable N/A
• May be exposed to outdoor weather conditions of cold, heat, wet, and humidity. Not Applicable N/A
• May be exposed to outdoor or warehouse conditions of loud noises, vibration, fumes, dust, odors, and mists. Not Applicable N/A
• Must be able to ascend and descend ladders, stairs, or other equipment. Not Applicable N/A
• Subject to exposure to hazardous material. Not Applicable N/A