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Care Management Nurse

Location : Puerto Rico
Job Type : Direct
Hours : Full Time
Travel : No
Relocation : No

Job Description :
Responsible for organizing, coordinating, and oversight care management services to patients within the handling chronic conditions that includes, but is not limited to: performing health risk assessment (HRA), planning, implementation and assessment of the needs, barriers and services of high risk and cost of members under these medical conditions to develop an individualized care plan (ICP).  Monitor the different stages of health of the special needs population (SNP). Effectively coordinates the services necessary to maintain an optimal level of health of the high-risk patient and facilitate access to medical care services.




·         Responsible for handling cases, while interfacing with key stakeholders (internal/external) to ensure optimal care management.


·         Collaborates in a patient care process to assess, plan, facilitates, coordinate, monitor and evaluate options and services that meets member’s needs.


·         Implements a comprehensive clinical carse management plan for each patient.


·         Obtain input from providers, patients and family as appropriate, and evaluates and revises the plan as needed.


·         Analyze patient variances from the plan and initiates the appropriateness steps to resolve discrepancies.


·         Assess and refer patients for special program/services when appropriate.


·         Support member in their representative regarding care, care transition and changes in health status.


·         Develops and implements transition of care for patients in conjunction with hospital-based care managers.


·         Performs telephone, email, fax and/or face to face interactions to determine needs for continued care.


·         Communicate patient benefits and responsibilities timely and accurately.


·         Provide coordination in caseload to ensure all elements and tasks are completed timely and ensure cases move through the process as required.


·         Responsible providing communications to patient’s healthcare providers other representatives and external stakeholders.


·         Perform quality checks and report trends to leadership and during interdisciplinary care team meetings accordingly.


·         Documents the progress of the condition of the member and all the arrangements made using the electronic application within the work plan and the electronic health record, according to the policies and procedures established.


·         Responsible for good housekeeping techniques adhering to quality and production standards while complying with all applicable company, state and federal standards.


Required Qualifications :
Bachelor’s Degree in Nursing with one (1) to three (3) years of clinical experience.




Current/ valid license in Puerto Rico Register Nurse, in Good Standing or without restrictions.




Member of College of Nursing Professional of Puerto Rico.
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