Registered Nurse, RN Case Manager- Home Health Nurse

Key Responsibilities: Conduct comprehensive clinical, environmental, and psychosocial assessments in patients' homes and community settings. Identify barriers to care, including housing, food insecurity, transportation, medication access, and social support. Develop, implement, and regularly update individualized patient-centered care plans. Coordinate care between patients, primary care providers, specialists, social workers, home health agencies, and other members of the interdisciplinary team. Connect patients and families with appropriate community resources and social services. Support patients with transitions of care, hospital discharges, and follow-up appointments to promote continuity and reduce avoidable hospitalizations. Educate patients and caregivers on disease management, medications, treatment plans, preventive care, and self-management strategies. Monitor patient progress and follow up on identified clinical and social needs. IV therapy and medication management Laboratory coordination Advocate for patients and help overcome barriers that may negatively impact health outcomes. Maintain accurate and timely documentation of assessments, care plans, interventions, and patient outcomes. Collaborate with providers and interdisciplinary teams to ensure patients receive appropriate and coordinated care. Promote patient engagement, adherence, and improved overall health outcomes.

Qualifications & Requirements: Active, unrestricted RN license in the state of Florida. Minimum 2 years of nursing experience. At least 1 year of experience in case management, home health, community health, public health, care coordination, or a related setting preferred. Experience working with Medicare Advantage, seniors, chronically ill, or medically complex populations preferred. Knowledge and understanding of Social Determinants of Health (SDOH) and community-based resources. Strong care coordination, communication, organization, and critical-thinking skills. Ability to work independently while collaborating effectively with an interdisciplinary care team. Current BLS certification required. Certified Case Manager (CCM) certification preferred. Valid Florida driver's license, reliable personal vehicle, and current automobile insurance required. Ability and willingness to travel regularly for in-home patient visits throughout the assigned service area. What MyCare Medical Offers Full-time Monday–Friday schedule Physician-founded, dyad-led organization Supportive interdisciplinary clinical team Patient-centered, value-based care environment Opportunity to make a meaningful impact on patients' health and quality of life Professional growth and development opportunities Competitive compensation and comprehensive benefits Bilingual (English-Spanish) Preferred LCSW a plus but not required Why MyCare Medical? At MyCare Medical, we believe healthcare is about more than treating a diagnosis. Our team works together to understand the whole patient—including their medical, social, and environmental needs —and connect them with the resources and care they need to thrive. If you are a compassionate RN who enjoys care coordination, patient advocacy, community-based care, and making a measurable difference in the lives of patients, we would love to hear from you. Pay range and compensation package Competitive Salary – Our base salary range for this position is $90,000 -$100,00 based on experience. xaygatp Equal Opportunity Statement ~ MyCare Medical is committed to diversity and inclusivity in the workplace.