Behavioral Health, Case Management, Chronic Disease, Clinical Medicine, Clinical Nursing, Clinical Support, Cross-Functional, Data Analysis, Detail Oriented, Director of Nursing (DON), Disease Prevention and Control, Electronic Medical Records, Health Education, Health Information Technology, Health Plan, Healthcare, Home Care, Hospital, Licensed Practical Nurse/Licensed Vocational Nurse, Medical Records, Medications, Microsoft Office, Nursing, Nursing Management, Organizational Skills, Patient Admissions, Performance Management, Primary Care, Quality Metrics, Reconciliation, Secondary School, Support Documentation, Team Player, Training/Teaching, Treatment Plan, Trend Analysis
To support the continued delivery of quality and compassionate care in our communities, we are offering a retention bonus of $4,000 for Nurses.* Your commitment helps us meet critical service needs, and we’re excited to have you be a part of our mission!
Deliver Whole-Person Care as a Nurse Care Manager – Primary Care Health Care Home
Schedule: Monday - Friday, 40 hours weekly.
Do you believe in the power of integrated care to transform lives? As a Nurse Care Manager in our Primary Care Health Home department, you’ll play a key role in supporting individuals with co-occurring medical and behavioral health needs through a person-centered, whole-health approach. This position combines hands-on clinical care with collaborative care coordination—ensuring our patients have the support they need to achieve better health outcomes.
This is a great opportunity for someone who thrives in a fast-paced, team-oriented primary care setting and is passionate about making a meaningful impact on health equity and chronic disease management in underserved communities.
Key Responsibilities
- Manage a caseload of up to 250 Health Care Home patients
- Complete annual care plans and ongoing monitoring of patients’ medical needs
- Develop and support health-related treatment plan goals for patients with chronic conditions
- Provide client education on health conditions, medications, prevention, and self-care
- Collaborate with primary care providers, care teams, and specialists to coordinate comprehensive care
- Monitor patient records, reports, and alerts (e.g., hospital admissions, medication needs) using HIT tools and EMRs
- Perform medication reconciliations after hospital discharges and assist with follow-up care
- Analyze data and trends (e.g., DRVS reports) and contribute to performance improvement efforts
- Support documentation and tracking of Uniform Data System (UDS) quality measures
- Serve as a clinical resource for patients, staff, and care team members
- Participate in multi-disciplinary team meetings and contribute to holistic care planning
- Seek and provide culturally responsive services to meet individual and family needs
- Report to the Regional Primary Care Nursing Director for clinical supervision and support
Requirements, Skills, Knowledge and Expertise
High School/GED required
Practical Nursing or Associate of Nursing degree required
Work Experience/Training/Additional Requirements:
- Proficiency in Microsoft Office Suite and Electronic Medical Records preferred
Licensure/Certification:
- Licensed Practical Nurse (LPN) required
You’ll Be A Great Fit for This Role if You:
- Are passionate about person-centered care and chronic disease management
- Feel confident navigating both primary care and behavioral health systems
- Excel in team-based settings and value collaboration with other providers
- Stay organized and detail-oriented in fast-paced clinical environments
- Are proactive in using data and health IT tools to drive patient outcomes
- Believe that integrated care is essential for promoting long-term wellness
*Retention bonuses paid as per bonus policy; exclusions may apply.
IND2