Nurse Care Manager

Upward Health

. Coordinate care for high-risk patients requiring comprehensive chronic-condition care plans .

Posted 10/8/2026full-timeAlbuquerque • New Mexico • United StatesMid-LevelSeniorWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in care management and coordination, with a focus on developing personalized care plans and supporting chronic care management. Proficient in using EHR systems for documentation and communication while maintaining patient confidentiality and adhering to HIPAA regulations.

Highest-signal resume keywords

Registered Nursing LicenseCare Management ExpertiseEHR Systems ProficiencyMedication ReconciliationCritical Thinking Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Chronic Disease ManagementCare Plan DevelopmentTelephonic Patient AssessmentsIn-Person Patient OutreachClinical JudgmentCare CoordinationPatient AdvocacySelf-Care Skills ImprovementDocumentation and TrackingCulturally Sensitive Care

Soft Skills

Strong Communication SkillsAbility to Work IndependentlyCollaboration with Multidisciplinary TeamsMotivational Skills

Tools & Technologies

EHR SystemsCare Management SystemsDigital Tools for Care Coordination

Certifications & Qualifications

Case Management Certification

Industry Keywords

Chronic Condition CareCare TransitionsPatient ConfidentialityHIPAA RegulationsAcute Care Experience

About the role

Key responsibilities & impact

Coordinate care for high-risk patients requiring comprehensive chronic-condition care plans
Work with a multidisciplinary Care Team to support optimal patient health outcomes
Develop personalized care plans addressing physical, behavioral, and social health needs
Support chronic care management and care transitions, especially after inpatient discharge
Conduct in-person and telephonic patient outreach and assessments
Perform medication reconciliation and ensure continuity of care across providers, hospitals, and outpatient services
Act as a patient advocate and educate patients, caregivers, and families about treatment options
Contact patients and caregivers within 48 hours of discharge
Coordinate care across multiple providers, institutions, and services
Manage multiple patient cases and meet care-plan deadlines
Identify gaps in care and resolve issues collaboratively with providers
Document, track, and coordinate care using EHR and care management systems
Motivate patients to follow care plans and improve self-care skills
Maintain patient confidentiality and follow HIPAA regulations

Requirements

What you’ll need

Registered nursing license (unrestricted)
Minimum of three years of clinical nursing experience
Expertise in care management and coordination across healthcare providers
Strong communication skills for patient and caregiver education
Ability to conduct both in-home and telephonic assessments, care plans, and medication reconciliations
Experience with EHR systems and real-time documentation
Ability to work independently and manage multiple patient cases
Critical thinking and decision-making skills in developing care plans
Proficient in using digital tools for care coordination and communication
A valid driver’s license and auto liability insurance
Reliable transportation and the ability to travel within assigned territory or as needed
Preferred experience in care management, case management, or transitional care settings
Experience in acute care environments such as ICU, Med-Surg, or ER is highly valued
Case management certification is preferred but not required
Knowledge of chronic disease management, care transitions, and evidence-based practices
Proficiency in creating personalized care plans
Ability to use electronic health records (EHR) and care management systems
Clinical judgment for assessing, analyzing, and evaluating patient progress
Ability to maintain patient confidentiality and follow HIPAA regulations
Respect for diversity and culturally sensitive care

Benefits

Comp & perks

Upward Health Benefits (benefits details provided via linked benefits page)