Care Manager, Complex Disease Management – Remote

Job Description Care Manager, Complex Disease Management – Remote **New York RN license required** Summary of Position: The Care Manager is responsible for providing care management as part of a multidisciplinary team. This includes coordinating care, conducting telephonic and face-to-face assessments, identifying gaps in care, and implementing interventions to support members’ physical, environmental, and psychosocial needs. The Care Manager works closely with providers, caregivers, and community resources to promote safe, effective, and member-centered care.

Assess and evaluate the needs of complex members, collaborating with caregivers, providers, and community resources to address medical, financial, and psychosocial concerns. Develop individualized care plans with clear goals and interventions, including referrals, education, and activation of support resources. Coordinate safe and timely transitions of care, ensuring members receive the right care at the right time in the right setting. Engage members, families, and primary care providers in setting and achieving care goals that improve health outcomes and quality of life. Collaborate with interdisciplinary team members such as dietitians, social workers, and community health workers to deliver holistic care. Act as an advocate and liaison for members, connecting them with providers, nonprofit, and governmental resources. Ensure compliance with federal, state, NCQA, and organizational standards in all care management processes. Document all activities in the electronic medical record system accurately and within required timeframes. Participate in case conferences, committee work, and training as assigned. Monitor and evaluate members’ progress, updating care plans as needed. Support population health, transitions of care, and complex case management initiatives.