RN Care Manager - Population Health - 01.07.2026

Founded in 2008, MVHC serves as a best-in-class health care resource to ensure all members of the communities we serve have access to high-quality, affordable health care. As your "community of care," we are dedicated to serving the primary care needs of the residents in each of our convenient locations in Muskingum, Morgan, Coshocton and Guernsey counties. We are local, non-profit, and community owned. The MVHC community is comprised of more than 500 staff and providers committed to health care, and we truly appreciate the opportunity to improve the lives of residents in the communities we serve!

MVHC is growing and has an immediate opportunity for an RN Care Manager to join our Team! Thank you for your interest in Muskingum Valley Health Centers and for considering MVHC as your next career path! At MVHC, we believe it takes a team to help change the face of health care. MVHC serves as a critical healthcare resource to ensure that all members of our community have access to affordable and high-quality health care. Our staff is dedicated, constantly learning, and eager to make a difference in the lives of the thousands of patients we serve each year. We strive to hire those who embrace our mission and values and pride ourselves in developing a team of employees that you can call family. If you want to make a difference and are passionate about what you do, consider MVHC for future employment and a rewarding career! We invite you to review the job posting below. If you meet the requirements and qualifications for this opportunity, we encourage you to apply. Assess patient health problems and needs, develop, and implement nursing care plans, and maintain medical records. Administer nursing care to ill, injured, convalescent, or disabled patients. Advises unlicensed staff on how to direct patients on health maintenance and disease prevention or provide case management. Assist in the management of high risk, complex patients. Identify the psychological, behavioral, emotional, and social factors important to the prevention, treatment, or management of physical health problems. Position details: Full Time Benefit Eligible Remote

Develops, implements, coordinates, and evaluates health care plans with interdisciplinary care teams to improve access to care, decrease hospitalization and ensure quality care is administered to all patients Collaborates with providers and practice staff in identifying appropriate patients for care management, utilizing established Care Management criteria Performs initial and periodic holistic assessments for care managed population. This includes physical and psychological on patients as appropriate. The assessment includes a systematic and pertinent collection of data about the health status of the patient. Prioritize patients according to intensity, need and required follow up Formulates and implements a care management plan that addresses the patient’s identified needs by assessing the patient/family needs, issues, resources, and care goals; determining the choices available to individual patients; educating the patient/family on the choices available Establishes a care management plan that is mutually agreed upon by the health care team and the patient/family. Plans specific mutual self-management goals and objectives and interventions with the patients that are action oriented Evaluates the effectiveness of the plan in meeting established care goals; revises the plan as needed to reflect changing needs, issues and goals. Monitors and evaluates the progress of the patient Collaborates with the healthcare team to revise the care management plan when changes occur. Initiates care conferences to discuss multidisciplinary team responsibilities, patient progress, new problems, etc. Identifies and effectively utilizes community resources to meet the needs of patients/families. Facilitates patient access to community resources as appropriate or refers to the Social Determinants team Promotes patient self-management and empowers patients/families to achieve maximum levels of wellness and independence. Interacts professionally with patient/family and involves patient/family in the formation of plan of care Performs follow up calls for patients recently discharged from acute hospitalizations and who are considered to be high risk for readmission Collaborates with providers, other healthcare team members to include inpatient facilities, the patient’s payer and health system administrators to transitions of care and facilitate care across the healthcare continuum and optimize clinical and financial outcomes Serves as a liaison to providers, patients, and families for coordination of services Maintains EMR databases on care managed population. Maintains accurate and timely documentation Strives to meet established standard for productivity, maintaining 50-100 patients Reviews utilization, UDS dashboard, and quality reports routinely. Scans for gaps in care and to identify patients needing the additional support of care management and identifies patients not in compliance with clinical measures thresholds Participates in regular team huddles. Participates in departmental and organizational committees, as applicable Participates in the orientation of new personnel. Precepts and mentors’ peers. Promotes collaborative teamwork Develops relationships across broad organizational lines and where innovative and unstructured situations arise. Relationships usually involve combined skills in communicating, understanding, developing, and motivating people to the highest degree. Meets with the Director of Value Based Care on a regular basis to provide patient updates identify issues and develop strategies for resolution Performs all duties and responsibilities in accordance with the Nurse Practice Act and in accordance with basic principles and guidelines of professional nursing Maintains appropriate professional boundaries Ensures documentation meets current standards and polices Maintains a working knowledge of, and adheres to applicable federal and state regulations including, but not limited to, laws related to patient confidentiality, release of information and HIPAA Interacts harmoniously and effectively with others, focusing upon the attainment of organizational goals and objectives through a commitment to teamwork Reports all accidents, regardless of severity, to Human Resources within 24 hours. These will be reported on the Employee Incident/Injury Report and Investigation form. Human Resources will monitor the timeliness of reporting Conforms to acceptable attendance and punctuality standards as expressed in the Employee Handbook Complies with all safety rules and protocols. Immediately reports any workplace injury to supervisor Abides by the organization’s compliance program and requirements Remains current on all required training Performs all other duties, as assigned by supervisor Administrative and Organizational Duties: Records all activity, including the care team management plan/self-management goals, into the Electronic Medical Record Assists in collection, computing and interpreting data for reporting Reports all activity to the Director of Value Based Care Provides monthly reports of care coordination activities and statistics to Care Coordination Supervisor Assists in assessing community health related needs and advocates for underserved population in service area Updates, monitors, and promotes services in the Resource Handbook