RN Clinical Care Manager

About the role

The RN Clinical Care Manager will lead relationships with physicians, provider offices, and Healthmap members participating in the Kidney Management Program. This role focuses on coordinating performance improvement and care management activities to enhance health outcomes for members with chronic kidney disease.

Key responsibilities

• Act as liaison between Healthmap, provider practices, and members to ensure engagement and program performance.
• Develop new provider and partner relationships to improve engagement and manage an assigned caseload.
• Identify opportunities to improve member health outcomes using provider‑specific data.
• Educate providers on best practices, workflow improvements, kidney health interventions, and HEDIS/STAR measures.
• Provide education to provider offices on chronic kidney disease, ESRD, and renal replacement therapies.
• Partner with physicians to identify members who would benefit from care navigation, conduct outreach, and engage them in the program.
• Advocate for members, connect them with community resources, and coordinate with their support network and care team.
• Maintain documentation of all interactions in compliance with NCQA standards and HIPAA regulations.
• Deliver timely reports to internal and external stakeholders and meet departmental KPIs.

Required profile

• Associate, diploma, or bachelor’s degree in nursing.
• Active, unrestricted RN license.
• Basic Life Support (BLS) certification.
• Advanced Cardiovascular Life Support (ACLS) certification.

Required skills