The RN Care Manager – Complex Care & High Utilizer Management is responsible for the comprehensive management of participants who exhibit high utilization of outpatient services.
Provide advanced clinical oversight, risk stratification, and proactive outreach to ensure participants receive timely, coordinated, and appropriate care.
Collaborate closely with medical providers, behavioral health specialists, and operational leaders to develop and implement strategies that reduce avoidable utilization.
Deliver ongoing care, support, and health education to participants with chronic illnesses.
Oversee the referral process for high-risk and complex participants to ensure clinical appropriateness and timeliness.
Monitor utilization patterns and proactively engage participants to reduce unnecessary service use.

BSN required
Current Registered Nurse (RN) license in New York State
Certification in Case Management (CCM) or equivalent, preferred
3+ years of clinical experience in chronic disease management, care coordination, or case management
Experience working with high‑risk, medically complex, or high‑utilizing populations
Strong assessment, communication, and interdisciplinary collaboration skills.
Experience in PACE, MLTC, Managed Care, or high‑risk care management preferred
Prior experience with behavioral health integration or complex psychosocial case management preferred

RN Care Manager – Complex Care & High Utilizer Management

Key skills