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Medical Case Manager New

Smithfield, RI


Hiring Company

Neighborhood Health Plan of Rhode Island

Positions Available

Full Time

Apply now

Position Description


The Medical Case Manager works collaboratively with the health care team to manage and coordinate care for a specific population of members whose needs represent high clinical and social risk in order to ensure quality and cost-effective member-centered care.


  • Practice case management within the scope of licensure.
  • Utilizes case management principles and sound clinical judgment in coordinating care for a specific member population
  • Performs intensive case management functions for identified individuals in order to promote quality, cost-effective outcomes, including but not limited to:
    • Performing a comprehensive assessment
    • Care planning activities including the development of interventions, short and long-term goals in collaboration with member, family, PCP, Behavioral Health Professionals and other involved health care professionals and community agencies, as appropriate
    • Implements care plan, facilitates referrals, coordinates services and resources and provides ongoing monitoring and re-evaluation of outcomes
    • Continuous monitoring and evaluation of the care outcomes and identification of service gaps
    • Regular review and revision of the plan of care in collaboration with the family and appropriate members of the health care team based on the outcomes and evaluative findings
    • Off-site visits (such as but not limited to home, hospital or community health centers or other community agencies) as necessary or required
  • Provides comprehensive documentation of all activities and contacts in Case Management software system
  • Facilitates referrals and coordinates needed services
  • Collaborates with team as necessary in identifying needed services and supports
  • Communicates with ancillary departments, such as Provider Relations and Member Services, as necessary to meet individual needs of members and providers
  • Meets department and regulatory standards for accuracy, proficiency and documentation in order to communicate decisions and plan of care in an appropriate and timely manner
  • Provides clinical oversight to community outreach and other team members; providing direct supervision of community outreach staff as appropriate regarding individual case status
  • Serves as a clinical resource to respond to questions from various departments
  • Provides cross-coverage as assigned
  • Participates in outreach/marketing activities as needed and as appropriate


  • Registered Nurse with an active, current, unrestricted license in RI in good standing OR
  • LICSW with active, current, unrestricted license in RI in good standing
  • Minimum of 3 years care management experience or community health nursing
  • PC based software programs – intermediate level of proficiency
  • Organizational skills – strong skillset
  • Customer service orientation
  • Strong interpersonal skills
  • Ability to work independently and prioritize activities
  • Must have access to reliable transportation. If using personal vehicle, must possess a valid Rhode Island driver’s license and current auto insurance


Neighborhood is an Affirmative Action and Equal Opportunity Employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, national origin, genetic information, age, disability, veteran status or any other legally protected basis.

Apply now

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