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Posted: 10/19/2026Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in care management, patient assessment, and coordination of services while adhering to CMS and NCQA standards. Proficient in educating patients and caregivers, addressing barriers to care, and performing cost-benefit analyses.
Highest-signal resume keywords
Registered Nurse (RN) LicenseBachelor's Degree in Nursing (BSN)Case Management CertificationClinical Nursing ExperienceKnowledge of Care Management
About the role
Key responsibilities & impact- Collaborate with physicians and healthcare team members to improve outcomes for patients with chronic conditions or complex needs
- Educate patients and caregivers to help them manage healthcare needs
- Facilitate communication and coordinate services
- Address barriers and promote optimal allocation of resources while balancing clinical quality and cost management
- Identify patient populations using screening criteria, medical record review, and referrals
- Review medical records, focused reports, and referral information to gather relevant data
- Interview patients, families, or significant others to obtain necessary information
- Assess patients or members according to CMS Condition of Participation or NCQA standards
- Develop and maintain plans of care consistent with applicable standards and department requirements
- Incorporate individualized member needs and goals throughout the care management process
- Coordinate communication among members, caregivers, healthcare teams, referral physicians, community organizations, post-acute providers, payers, sales teams, and employer groups
- Intervene to resolve or escalate barriers to service across the care continuum
- Maintain current knowledge of community resources
- Perform cost-benefit analysis and coordinate services when necessary
- Perform other clinical duties as assigned
Requirements
What you’ll need- RNs hired or promoted into this role need to have or obtain their BSN within three years of hire or promotion
- Current RN license in state of practice
- Two years of clinical nursing experience
- Bachelor's degree in Nursing (BSN) from an accredited institution preferred
- Case Management Certification preferred
- Experience working in clinical care management or with third party payers preferred
- Knowledge of care management
- Knowledge of health insurance related products
- Working understanding of coding, episode of care and length of stay guidelines
- Ability to communicate information verbally and in writing
- Ability to operate computers and office equipment
- Ability to read computer monitors and documents
- Ability to remain sitting or standing for long periods while working on a computer, telephone, or other equipment
Benefits
Comp & perks- Benefits eligible
- Generous benefits package covering programs supporting wellness, health, security, connection, and engagement
- Company equipment and remote-work support for hybrid work
- Equal opportunity employment
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Patient AssessmentCare ManagementMedical Record ReviewCost-Benefit AnalysisCoding GuidelinesHealth Insurance KnowledgeScreening CriteriaPlan of Care DevelopmentData GatheringClinical Duties
Soft Skills
Communication SkillsInterpersonal SkillsProblem-Solving SkillsCollaboration SkillsOrganizational Skills
Tools & Technologies
Office EquipmentComputers
Certifications & Qualifications
Case Management Certification
Industry Keywords
Chronic ConditionsHealthcare Team CollaborationPatient EducationResource AllocationCMS Condition of ParticipationNCQA StandardsThird Party PayersCommunity Resources