Remote RN Care Manager (Managed Care / LTSS)
Job Number: NR31057461
Pay Rate: $72000-83400 / year
Job Description
Remote RN Care Manager (Managed Care / LTSS)
Required: Professional Licensure: Active, unrestricted Registered Nurse (RN) license in the state of Pennsylvania (or an active NLC Multistate license).
Role Type: Full-Time, Employee of the Company (Not a temp or contract assignment)
Shift: Day Job (Monday–Friday; no weekends, holidays, or on-call requirements)
Work Arrangement: Remote (100% work-from-home position with zero travel)
Location: Remote / Pittsburgh, PA 15219
New Hire Starting Salary Range: $72,000 – $83,400 annually, to start (Future increases based on performance, see below).
About the Opportunity
This is a permanent, full-time career opportunity supporting Pennsylvania’s managed care Long-Term Services and Supports (LTSS) program. If selected, you will be hired directly as a regular employee of the organization we represent. You will be on their payroll and eligible for their full suite of benefits from your start date. This is not a temporary, contract, or "temp-to-hire" role. This position offers a 100% remote layout, allowing you to manage care telephonically from a private home office.
Purpose
The RN Care Manager (Managed Care / LTSS) manages a dedicated participant caseload, providing episodic care management, health education, and essential community resources to seniors and individuals with physical disabilities covered by Medicare and Medicaid. Operating entirely by telephone and electronic communication, this professional conducts comprehensive clinical assessments to identify medical, behavioral, pharmacy, and social barriers to care. The final objective is to build an individualized care plan that closes preventive care gaps, supports chronic illness self-management, and significantly reduces unnecessary ER utilization and hospital readmissions.
Responsibilities
- Caseload Assessment: Conduct virtual, comprehensive assessments addressing the medical, behavioral, pharmacy, and social determinants of health affecting participants and their caregivers.
- Care Plan Development: Engage participants to establish an individualized plan of care in collaboration with primary care providers, establishing goals that promote healthy lifestyles and clinical compliance.
- Gap Closure & Outreach: Analyze health plan data to isolate clinical care gaps, actively contacting participants to assist them in scheduling required screenings or diagnostic testing.
- Interdisciplinary Coordination: Coordinate and modify care plans by collaborating with participants, family caregivers, PCPs, medical specialists, community agencies, and behavioral health partners.
- Patient Education: Deliver targeted educational materials and resources to enhance participants' knowledge and self-management skills regarding chronic physical health conditions, emotional wellness, or lifestyle adjustments.
- Documentation & Analytics: Maintain highly detailed, precise data entries within the internal care management tracking system, ensuring strict adherence to compliance standards while identifying systematic operational trends.
Minimum Essential Requirements
- Education: Graduate of an accredited school of nursing required. (Bachelor of Science in Nursing is preferred).
- Experience: Minimum of two (2) years of direct experience in a clinical care setting combined with professional case management nursing experience.
- Professional Licensure: Active, unrestricted Registered Nurse (RN) license in the state of Pennsylvania (or an active NLC Multistate license).
- Prior service coordination experience within community or nursing facility environments
- Background leading interdisciplinary teams through discharge planning or transitions of care
- Strong working knowledge of Medicaid, Medicare, and LTSS waiver programs
- Active professional certification in Case Management (CCM) is highly valued.
- Technical & System Competency: Strong computer proficiency is required. Must meet minimum internet system speed and latency requirements, including a dedicated workspace where equipment is hard-wired directly via ethernet cable to the modem or router.
- Communication Skills: Superior verbal and written communication skills with a proven ability to interact professionally with physicians, multi-tiered healthcare professionals, and vulnerable populations.
- Background Clearances: Ability to clear all required background checks (Act 34).
Future Performance-Based Earning Potential
This role offers a structured path for financial advancement. Through consistent high performance, leadership development, and continuous learning over time, employees have the opportunity to earn up to $56.83 per hour.
Premier Benefits
- Exceptional Retirement Package: Retirement plans with employer matching. Combined, the organization contributes up to 8% of your eligible pay toward your future.
- World-Class Healthcare: Access preventive care and specialty services through an exclusive provider network.
- Generous Paid Time Off: Enjoy up to 5.5 weeks of PTO per year, plus 7 paid holidays, with unique options to buy or sell PTO days to fit your lifestyle.
- Tuition Assistance: Benefit from up to $6,000 per academic year in tuition reimbursement, plus exclusive tuition discounts at over 30 partner colleges and universities.