Care Management Specialist

About the role

The Care Management Specialist conducts nursing functions to assess, plan, and coordinate care for policyholders with chronic medical conditions. This role develops individualized care plans, monitors progress, and ensures timely access to required health services.

Key responsibilities

• Evaluates admission criteria for Complex Care Management Programs and conducts health risk assessments.
• Develops comprehensive, individualized care plans using clinical guidelines and monitors their effectiveness.
• Identifies barriers to care, sets achievable goals, and implements case management strategies.
• Coordinates referrals, communicates with physicians, providers, and policyholders, and documents all actions in the electronic system.
• Participates in interdisciplinary team meetings, case discussions, and special projects to meet compliance and quality measures.

Required profile

• Bachelor’s degree in Nursing Sciences.
• Minimum two years of experience providing direct care to patients with chronic health conditions.
• Valid nursing license from the Association of Nursing Professionals of Puerto Rico.
• Intermediate proficiency in Spanish and English (reading, writing, speaking).

Required skills

• Computer systems
• MS Office