MedStar Health · 12 hours ago
RN CTO Lead Care Manager
Baltimore, MD
Full-time
Onsite
Mid Level
3+ years expMedStar Health is a healthcare organization that provides care coordination for Medicare beneficiaries. The RN CTO Lead Care Manager serves as a liaison between medical practices and the CTO care team, ensuring timely access to care and managing a caseload of patients while collaborating with an interdisciplinary team.
Health CareMedical
Responsibilities
Contributes to departmental goals and complies with all policies, procedures, quality, safety, and regulatory standards
Serves as the care coordination lead for a panel of attributed Medicare beneficiaries in collaboration with the interdisciplinary team
Ensures timely access to care, post-discharge follow-up, and use of alternative visit options (phone, e-visits, group, home, and community-based visits)
Assists with appointment scheduling, including annual wellness visits
Ensures follow-up within two days of hospital discharge and within one week of Emergency Department visits
Coordinates referrals to high-volume and high-cost specialists, hospitals, and emergency services
Connects patients to behavioral health and community resources and supports advance care planning and PFAC participation
Provides direct patient care under physician direction, including wellness visits, transitional care, vaccinations, and screenings
Manages a caseload in accordance with MD Primary Care Program (MDPCP) standards, including assessments, care planning, and outcome monitoring
Conducts comprehensive assessments and interventions for high-acuity patients
Evaluates and adjusts care plans to promote quality, cost-effective care
Acts as a patient and family advocate and liaison among physicians, facilities, and community partners
Provides clinical guidance to care team members to support effective care delivery
Maintains regular patient and provider communication to close gaps in care, support preventive services, and promote engagement using available data tools
Facilitates team communication through huddles, meetings, conference calls, and written updates
Analyzes patient data and presents actionable insights to support care coordination and quality improvement
Participates in quality improvement initiatives, committees, and community outreach as assigned
Performs other duties as assigned
Qualification
Required
Associate's degree in Nursing (ADN) required
3-4 years Work experience including 1 or more years of proven case management experience. Familiarity with the local area and/or population health workforce integration required
RN - Registered Nurse - State Licensure and/or Compact State Licensure Registered Nurse licensed in the State of Maryland Upon Hire required
DL NUMBER - Driver License Valid and in State (DRLIC) Upon Hire required
Effective verbal and written communication skills
Excellent interpersonal and customer service skills especially serving geriatric patients
Strong analytical and critical thinking skills
Strong community engagement and facilitation skills
Advanced project management skills
Commitment to collective impact concepts
Flexibility and the ability to work autonomously as well as take direction as needed
Cultural competency
Proficient computer skills along with experience using Microsoft applications-Word Excel etc. and familiarity with entering data in an electronic medical record (EMR)
Preferred
Bachelor's degree in Nursing (BSN) preferred
Experience with data collection and reporting; community outreach experience working in an ambulatory setting preferred
CCM - Certified Case Manager from a nationally recognized certification agency within 1-1/2 Yrs preferred
Company
MedStar Health
MedStar Health is a not-for-profit healthcare organization
10001+ employees
H1B Sponsorship
MedStar Health has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (18)
2024 (13)
2023 (14)
2022 (14)
2021 (12)
2020 (14)
Funding
Current Stage
Late StageTotal Funding
$29MKey Investors
American Medical AssociationAgency for Healthcare Research and QualityA. James and Alice B. Clark Foundation
2023-06-21Grant
2022-09-27Grant· $2M
2020-07-03Grant· $27M
Leadership Team
David Mayer
Executive Director MedStar Institute for Quality and Safety Quality and Safety CEO Patient Safety Mo
Recent News
2025-12-17
Maryland Daily Record
2025-12-05
Company data provided by crunchbase