TCHP Care Manager-RN - Ft Wright Care Management - Full Time - Days

The Ambulatory Care Manager (RN) provides comprehensive clinical care management services to identified eligible patients across the healthcare continuum. This role focuses on coordinating care to improve health outcomes, enhance patient self-management, reduce unnecessary utilization, and ensure cost-effective, high-quality care. The Care Manager performs standardized comprehensive assessments, identifies and addresses barriers to care, and collaborates with patients, providers, and the interdisciplinary care team to develop and implement individualized care plans. The role primarily supports high-risk patients with multiple comorbidities or increased risk for hospital admission or readmission and facilitates seamless care transitions following inpatient or emergency department encounters. The role’s high-level goal is to reduce readmissions by facilitating smooth transitions and identifying and mitigating risks.