Nurse Care Manager

Patient First

. Serve as a telephonic care management resource to clinical teams and integrate the care management program into physician practices .

Posted 9/21/2026full-timeRemote • Maryland • United StatesMid-LevelSenior💰 $35 - $49 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in telephonic care management, chronic disease management, and quality improvement strategies. Proficient in developing and implementing care plans, conducting comprehensive clinical assessments, and facilitating effective communication among care teams and patients.

Highest-signal resume keywords

RN LicensureTelephonic Triage ExperienceCase Management CertificationChronic Disease ManagementQuality Improvement Experience

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Comprehensive Clinical AssessmentCare Plan DocumentationData AnalyticsPatient Engagement TechniquesMotivational Interviewing

Soft Skills

Interpersonal CommunicationProblem-SolvingDecision-MakingOrganizational SkillsActive Listening

Tools & Technologies

Electronic Medical Record SystemsMicrosoft WordMicrosoft ExcelPatient Portal

Certifications & Qualifications

CPR CertificationACLS CertificationPALS Certification

Industry Keywords

Chronic Care ManagementPatient-Centered Medical HomeQuality MeasuresCare CoordinationHIPAA Compliance

About the role

Key responsibilities & impact

Serve as a telephonic care management resource to clinical teams and integrate the care management program into physician practices
Define quality measures, establish goals, and develop protocols and point-of-care reminders using nationally recognized, evidence-based care quality measures
Improve the effectiveness and efficiency of clinical practices and processes
Review medical records and internal and external reports to identify and research gaps in care
Develop and implement practice-level strategies to address and close gaps in care
Identify patients appropriate for care management
Maximize patients’ health, wellness, safety, self-care, satisfaction, and cost-efficiency
Provide advice to center nurses and health care team members and handle emergent or urgent calls within scope of practice
Actively manage an assigned panel of chronic care patients telephonically
Assess patients’ physical and psychosocial needs, literacy status, and barriers
Educate patients and health care team members about preventive care and care coordination
Support complete health assessments and payor contractual requirements
Coordinate change readiness and needs assessments and develop individualized treatment care plans
Monitor and evaluate care plan effectiveness and modify plans as necessary
Provide expert clinical guidance to improve patients’ overall wellbeing
Help patients set SMART self-management goals and teach self-management tasks
Report abnormal findings to the care team
Promote patient engagement and self-management
Document self-management measures, care plans, and progress toward goals
Collaborate with patients, families, caregivers, physicians, and care team members
Manage referrals, hospitalizations, ER visits, ancillary testing, medication reconciliation, and care coordination
Communicate with patients regarding recommendations and follow-up visits
Review provider documentation, follow up with patients, and document conversations and recommendations in the electronic medical record
Follow Patient First protocols for urgent and emergent calls
Anticipate chronic care patient needs and conduct pre-visit planning
Instruct and encourage patients to use the Patient First patient portal
Facilitate communication between care team members and patients in decision-making
Use motivational interviewing to assess and mitigate barriers to treatment goals
Oversee development, procurement, and adoption of patient self-management educational resources
Collaborate with external case managers and develop medical supply and community resource lists
Work with physicians, hospitals, ERs, and other health care resources to clarify roles and improve communication
Facilitate, advocate, and intervene to ensure treatment plan implementation and continuity of care
Work as a center staff nurse as directed

Requirements

What you’ll need

Eighteen years of age or older
RN licensure required
Ability to be licensed in all states in which Patient First operates
Current CPR, ACLS, and PALS certifications
Minimum of three years’ clinical experience in medical/surgical, ER, critical care, and ambulatory care preferred
Certification as a Case Manager or experience in Case Management and Primary Care/Patient-Centered Medical Home Care or environment that coordinates care across multiple providers preferred
Telephonic triage, coaching, or care coordination experience required
Ability to work in a team-oriented environment
Highly organized with well-developed oral, written, presentation, and interpersonal communication skills
Sound judgment and decision-making, problem-solving, and analytical skills
Strong professional-level knowledge of comprehensive clinical assessment in the primary care population and chronic disease management
Knowledge of psychosocial aspects of chronic illness
Experience in quality improvement, quality and efficiency metrics, and data analytics preferred
Demonstrated success in influencing patients and providers
Experience with medically oriented care plan documentation; ability to develop and implement plan of care
Skilled in active listening, critical thinking, social perceptiveness, active learning, and instruction methods for patient engagement and activation
Comfortable managing multiple tasks and continually re-prioritizing
Ability to delegate and make sound judgment while working with employees and providing medical care
Ability to work effectively with all levels of administrative and professional personnel
Able to maintain confidentiality in accordance with the organization and HIPAA
Proficient computer skills, including Microsoft Word and Excel, presentation preparation, and database management
Must be able to hear pages, bells, and phone system
Must be able to sit, stand, and walk for long periods of time, possibly 4 to 7 hours at a time
Ability to travel, including overnight, to attend meetings, conferences, and other events as needed
Ability to work extended hours, including nights and weekends, as needed
Bilingual a plus

Benefits

Comp & perks

Sign-on Bonus
Health, Dental and Vision insurance for employees and dependents
Disability, Life and Long Term care insurance
Employee Assistance Program
Flexible Spending accounts
401(k) Retirement Plan (with employer match)
Paid Annual Leave
Volunteer Time Off Pay
Bereavement Leave
Emergency Leave Bank
Overtime Pay
Holiday Pay
Double time compensation for all holidays worked
Discounted medical treatment at any Patient First location for employees and immediate family
Recruitment Bonus