Registered Nurse - Care Manager - Value Based Care - High-Risk Member Care Navigation

Registered Nurse

• Care Manager
• Value Based Care
• High-Risk Member Care Navigation Care Advantage Inc. Corporate Richmond, VA Job Details Full-time 1 day ago Qualifications RN License RN experience Microsoft Teams Productivity software Full Job Description 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 Value‑Based Care RN Care Manager, you'll be at the heart of our mission-guiding high‑risk 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 relationship‑based 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 high‑touch, member‑centered care that respects each individual's unique needs

Attitude:

Bring positivity, resilience, and solutions‑focused thinking to every interaction

Respect:

Partner collaboratively with members, caregivers, providers, and health plan leaders

Excellence:

Drive measurable outcomes through data‑informed care management and continuous improvement What You'll Do High‑Risk Member Outreach & Care Navigation Serve as the central clinical point of contact for an assigned panel of high‑risk Medicaid VBC members Conduct proactive telephonic and in‑home 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 follow‑up 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 high‑risk member cases and aligned care strategies Prepare and maintain rounding materials, track outcomes, and drive follow‑through 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 plan‑specific 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 self‑management 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 (Value‑Based Care or population health strongly preferred) Experience with high‑risk member outreach and post‑discharge follow‑up 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 Field‑based 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? Purpose‑driven work with measurable impact Collaborative, mission‑focused leadership Opportunity to shape and grow innovative Value‑Based 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, value‑based 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