Care Manager, RN

Astrana Health

Care Manager RN responsible for improving clinical outcomes and promoting quality care for members with complex needs. Collaborates with interdisciplinary teams and community resources.

Posted 6/24/2026full-timeJohnston • Rhode Island • 🇺🇸 United StatesJuniorMid-Level💰 $40 - $48 per hourWebsite

About the role

Key responsibilities & impact

Conduct comprehensive health assessments, including medical, behavioral, and social determinants of health (SDOH)
Develop, implement, and evaluate individualized care plans based on member needs, goals, and risk level
Coordinate care across multiple settings, including inpatient, outpatient, and community-based services
Facilitate transitions of care, including hospital discharge planning and post-discharge follow-up
Utilize clinical expertise to identify gaps in care, potential risks, and opportunities for early intervention
Monitor member progress and adjust care plans accordingly
Provide education to members and caregivers regarding disease management, medications, and treatment plans
Apply evidence-based guidelines and best practices in care management
Support appropriate utilization of healthcare services to ensure cost-effective care delivery
Collaborate with utilization management teams to reduce avoidable hospitalizations and emergency department visits. Identify high-risk members and implement strategies to improve outcomes and reduce healthcare costs
Partner with physicians, specialists, behavioral health providers, and community agencies to coordinate care
Serve as a liaison between members, providers, and health plan resources
Participate in interdisciplinary team meetings and case conferences
Maintain effective communication to ensure continuity of care
Ensure timely and accurate documentation in accordance with regulatory, CMS, and organizational requirements
Support quality improvement initiatives, including HEDIS, STAR ratings, and other performance measures
Maintain compliance with accreditation standards and internal policies
Conduct outreach to engage members in care management programs
Promote self-management and adherence to treatment plans. Address barriers to care, including social, economic, and cultural factors

Requirements

What you’ll need

Bachelor of Science in Nursing (BSN) preferred; Associate degree in Nursing required
At least 2 years of clinical nursing experience (case management, acute care, or managed care preferred)
Certifications & Licensure Active, unrestricted Registered Nurse (RN) license
ACM (Accredited Case Manager) certification required or must be obtained within a specified timeframe
CCM (Certified Case Manager) may be considered in lieu of or in addition to ACM (depending on organizational requirements)
Strong knowledge of care management principles, utilization management, and population health
Understanding of regulatory standards (CMS, NCQA, etc.). Ability to assess and manage complex clinical and psychosocial situations
Excellent communication, collaboration, and critical-thinking skills
Proficiency in electronic health records (EHR) and care management documentation systems
Ability to manage multiple priorities in a fast-paced environment
Experience in care coordination, discharge planning, or population health strongly preferred

Benefits

Comp & perks

This role follows a hybrid work structure where the expectation is to work on the field and at home on a weekly basis. The home office is located at 1301 Atwood Avenue, Suite 206N, Johnston, RI 02919.
This position requires up occasional travel for onsite visits or team meetings.
Astrana Health is proud to be an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based on race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. All employment is decided based on qualifications, merit, and business need. If you require assistance in applying for open positions due to a disability, please email us at humanresourcesdept@astranahealth.com to request an accommodation.

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Hard Skills & Tools

clinical nursingcase managementacute caremanaged carecare coordinationdischarge planningpopulation healthevidence-based guidelineshealth assessmentsrisk assessment

Soft Skills

communicationcollaborationcritical thinkingorganizational skillsinterpersonal skillsproblem-solvingeducationadaptabilitytime managementteamwork

Certifications

Registered Nurse (RN) licenseAccredited Case Manager (ACM)Certified Case Manager (CCM)