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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 ValueBased Care RN Care Manager, you'll be at the heart of our mission-guiding highrisk 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 relationshipbased 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 hightouch, membercentered care that respects each individual's unique needs
• Attitude: Bring positivity, resilience, and solutionsfocused thinking to every interaction
• Respect: Partner collaboratively with members, caregivers, providers, and health plan leaders
• Excellence: Drive measurable outcomes through datainformed care management and continuous improvement

What You'll Do

HighRisk Member Outreach & Care Navigation

• Serve as the central clinical point of contact for an assigned panel of highrisk Medicaid VBC members
• Conduct proactive telephonic and inhome 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 followup 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 highrisk member cases and aligned care strategies
• Prepare and maintain rounding materials, track outcomes, and drive followthrough
• 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 planspecific 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 selfmanagement
• 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 (ValueBased Care or population health strongly preferred)
• Experience with highrisk member outreach and postdischarge followup
• 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

• Fieldbased 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?

• Purposedriven work with measurable impact
• Collaborative, missionfocused leadership
• Opportunity to shape and grow innovative ValueBased 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, valuebased outcomes, and building meaningful relationships-we'd love to meet you.

Apply today and help redefine care for those who need it most.

Location: 23173, 23218, 23219, 23220, 23221, 23222, 23223, 23224, 23225, 23226, 23227, 23229, 23230, 23231, 23232, 23234, 23235, 23241, 23249, 23260, 23261, 23269, 23274, 23276, 23278, 23279, 23284, 23285, 23286, 23289, 23290