Transitions of Care RN Case Manager

Devoted Health

. Provide telephonic, short-term, interdisciplinary care management during the 30 days post-discharge for patients at high risk for readmission .

Posted 11/2/2026full-timeRemote • United StatesMid-LevelSenior💰 $85,000 - $100,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in telephonic care management, patient advocacy, and interdisciplinary coordination to enhance post-discharge outcomes. Proficient in developing personalized care plans and educating patients on chronic conditions while ensuring adherence to quality metrics.

Highest-signal resume keywords

RN LicenseTelephonic Care ManagementCare Plan DevelopmentPatient EducationClinical Analytical Thinking

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Care ManagementPatient AssessmentMedication AdherenceChronic Condition EducationData Tools Utilization

Soft Skills

Patient AdvocacyCommunicationTrust BuildingCollaborationEmpathy

Tools & Technologies

Technology for Patient EngagementData Analysis Tools

Certifications & Qualifications

Unrestricted Compact RN License

Industry Keywords

Medicare AdvantageTransitions of CarePopulation HealthSpecial Needs PlanHealthcare Coordination

About the role

Key responsibilities & impact

Provide telephonic, short-term, interdisciplinary care management during the 30 days post-discharge for patients at high risk for readmission
Advocate for patients by coordinating care and ensuring necessary resources and support
Engage newly discharged patients telephonically to understand their needs using technology and data tools
Conduct assessments covering comorbid conditions, ED/hospitalization history, medications, psychosocial factors, and patient values and preferences
Develop care plans with patients and caregivers, including problems, goals, and interventions, and continuously evaluate progress
Explain complicated medical terms in plain language
Educate patients on chronic conditions, red flags, exacerbation plans, and barriers to medication adherence
Provide active care management to close care gaps
Partner with TOC Nurse Practitioners and Physicians for smooth handoffs, follow-up, and coordinated post-discharge care
Refer patients to Devoted Medical when applicable
Work with Devoted Community Guides to identify community-based organizations
Coordinate post-treatment care and DME needs
Collaborate with PCP partners to coordinate evidence-based, effective, and accessible healthcare

Requirements

What you’ll need

An unrestricted Compact RN license obtained in the United States with the ability to secure other licensure states
3-4 Years of Experience of RN Care Management/telephonic case management experience
Located in CT/MT/PT time zones
Enthusiasm for working in a setting where meaningful time is spent on the phone with patients and/or their caregivers to build trust, educate, and coordinate care
Comfort and confidence working in an environment guided by performance and productivity metrics, with a focus on quality outcomes and patient experience
Health insurance experience, particularly Medicare Advantage
Prior Special Needs Plan, Population Health, or Transitions of Care case/care management experience
Clinical analytical thinking that allows you to apply your skills to the individual needs of each patient
Telephonic care/case management experience

Benefits

Comp & perks

Employer sponsored health, dental and vision plan with low or no premium
Generous paid time off
$100 monthly mobile or internet stipend
Stock options for all employees
Bonus eligibility for all roles excluding Director and above
Parental leave program
401K program