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Care Coordinator/Case Management - RNs

Location : Roanoke, VA
Job Type : Temp/Contract

Job Description :
We are currently seeking RNs in a Care Coordinator/Case Management position for the Roanoke, VA area. 


Summary is below:

RN Care Coordinator will be responsible for completing comprehensive assessments and plans of care for dual eligible members residing in nursing facilities.  In addition, Care Coordinators will be responsible for conducting interdisciplinary care team (ICT) meetings, which includes inviting assigned members, leading the meeting, and communicating changes in care needs to the team.

The Care Coordinator will be expected to build a rapport with providers, care partners (PCP, social workers, therapists, RNs, etc), as well as patients and/or their representatives.  As a Care Coordinator, you will need to demonstrate the ability to communicate effectively with patients who may have complex medical needs, and/or communication barriers.


Duties & Responsibilities: 

Completes a face to face comprehensive assessment of the member's health and psychosocial needs. 

Comprehensive assessments will be completed timely to meet contractual terms.  Initial assessments must be completed within 60 days of admission to the nursing facility, annually, and when there is a significant change in condition.

Works in partnership with the interdisciplinary care team to develop a plan of care for member. Identifies patient goals and approaches, and updates as needed.

Ensures that plans of care are person centered, that the member and/or family is the primary decision maker and involved in the care plan process.

Strives to promote member self-advocacy and self-determination

Ensures that the services that the member receives are appropriate to meet their medical 


Acts as an advocate for the member's health care needs.

Promotes education of medical health conditions.  Ensures that the member and/or their caregiver are educated on managing their medical condition and comorbidities to help them attain set goals and improve medical outcomes.

Works collaboratively with direct care staff, the enrollee, the interdisciplinary team, physician(s), and the MCO Care Manager in the management of the members health needs. 

Coordinates care services between the nursing facility and the managed care organization. 

Promotes high quality outcomes and better utilization of long term care services.

Assists the member in the safe transitioning of care to the next most appropriate care level.

Ensures all mandatory training is completed on time.

Practices in accordance with applicable local, state, and federal laws which govern confidentiality and medical information privacy regulations (HIPAA).

Registered Nurse or BSN, licensed in Virginia

At least one year of experience working as a licensed RN 

Experience navigating resources & computer system to access information 


Special Position Requirements:

Regular local travel (within Roanoke, VA) will be required

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