Population Health RN Case Manager - Family Medicine, Centerfield

Job Summary:

The RN Case Manager works collaboratively with physicians, interdisciplinary teams, patients, and families to promote positive patient outcomes through transitions of care and longitudinal care management. The RN Case Manager performs comprehensive assessments, develops individualized care plans, coordinates services across the continuum of care, and supports patients in achieving their health goals.

The RN Case Manager serves as the primary clinical resource for high-risk patients and those recently discharged from acute care settings. In addition to nursing case management responsibilities, the role provides psychosocial support and assists patients with social determinants of health needs, including transportation, housing, food insecurity, financial assistance, and community resource referrals. Complex behavioral health and social work needs are escalated or referred appropriately.

Key Responsibilities:

RN Case Management (Approximately 80-90%)

• Provide transitional care management following emergency department visits and hospital discharges.

• Manage longitudinal care for high-risk and medically complex patients.

• Perform comprehensive assessments and develop individualized care plans.

• Monitor patient progress and modify care plans as needed.

• Coordinate care across primary care, specialty care, hospitals, home health agencies, and community organizations.

• Promote disease self-management, medication adherence, preventive care, and patient education.

• Collaborate with providers and interdisciplinary teams to improve quality and value-based care outcomes.

• Serve as a patient advocate and clinical liaison with outside agencies and healthcare partners.

• Maintain accurate documentation and participate in quality

Social Determinants of Health and Resource Navigation (Approximately 10-20%)

• Assess psychosocial barriers affecting health outcomes.

• Assist patients with access to transportation, housing, food resources, financial assistance, insurance programs, and other community resources.

• Provide emotional support and crisis intervention within scope of practice.

• Facilitate referrals to behavioral health, social work, and community-based organizations as appropriate.

• Educate patients and families regarding available support services.

• Collaborate with social workers, behavioral health providers, and community partners to address non-medical needs affecting health.

• improvement initiatives.

Work Location:

Hybrid - this role is eligible for a hybrid schedule of 4 days per week in clinic located in Denver, CO and as needed for in-person meetings.

Why Join Us:

Community Practice Medicine, housed within the School of Medicine at the University of Colorado, is seeking trained medical professionals to join our growing team. With clinics spanning from Longmont to Castle Rock, we offer a wide variety of opportunities. Specialty areas include, but are not limited to: Orthopedics, Vascular Surgery, OBGYN, Internal Medicine, Urology, Psychiatry, and many more!

CU Medicine Family Medicine- Centerfield is committed to continuity, whole-person care, and serving as an innovation site for new models of primary care. Team members are expected to embrace rapid-cycle improvement, collaborate across disciplines, and contribute to the evaluation and implementation of new technologies, workflows, and care delivery approaches that can be scaled across the organization. We value curiosity, transparent communication, and individuals who are willing to "raise their hands first" and actively participate in shaping the future of patient-centered care.

The University of Colorado Anschutz Medical Campus is a public education, clinical and research facility serving 4,500 students, and a world-class medical destination at the forefront of life-changing science, medicine, and healthcare. CU Anschutz offers more than 42 highly rated degree programs through 6 schools and colleges and receives over $500 million in research awards each year. We are the single largest health professions education provider in Colorado, awarding nearly 1,450 degrees annually. Powered by our award-winning faculty, renowned researchers, and a reputation for academic excellence, the CU Anschutz Medical Campus drives innovation from the classroom to the laboratory to the delivery of unparalleled patient care.

Why work for the University?

We have AMAZING benefits and offer exceptional amounts of holiday, vacation and sick leave! The University of Colorado offers an excellent benefits package including:

• Medical: Multiple plan options

• Dental: Multiple plan options

• Additional Insurance: Disability, Life, Vision

• Retirement 401(a) Plan: Employer contributes 10% of your gross pay

• Paid Time Off: Accruals over the year

• Vacation Days: 22/year (maximum accrual 352 hours)

• Sick Days: 15/year (unlimited maximum accrual)

• Holiday Days: 15/year

• Tuition Benefit: Employees have access to this benefit on all CU campuses

• ECO Pass: Reduced rate RTD Bus and light rail service

There are many additional perks & programs with the CU Advantage.

Qualifications:

Minimum Qualifications:

• Bachelor's degree in nursing, biological science, or a directly related field from an accredited institution.

• Two (2) years of registered nurse experience in a clinical/hospital setting.

• One (1) year of experience in case management in specialty area.

  • A combination of education and related technical/military/paraprofessional experience may be substituted for a bachelor's degree on a year for year basis.

Applicants must meet minimum qualifications at the time of hire.

Preferred Qualifications:

• Three or more (3+) years registered nurse experience in a clinical/hospital setting.

• Two or more (2+) years of experience in case management in specialty area.

• Experience with transitions of care and ambulatory longitudinal care management.

• Experience addressing social determinants of health and community resource coordination.

• Experience in primary care, population health, or value-based care.

• Bilingual, Spanish-speaking.

• Nursing certification (ANCC) in specialty area.

• Kronos, Epic, and Health Stream experience.

Conditions of Employment:

• Applicants must be legally authorized to work in the United States without requiring sponsorship. We are unable to provide work visa sponsorship or employment authorization for this position now or in the future.

• Registered Nurse (RN), State of Colorado.

• Current Basic Life Support (BLS) for Healthcare Providers issued by American Heart Association or American Red Cross healthcare provider level CPR certification.

• Maintains all required licensure and certifications for position.

• Maintains all required continuing education requirements.

• Must be able to work in-person or have reliable internet for remote work as approved.

• Must be able to travel/cover to alternate locations as assigned.

Knowledge, Skills and Abilities:

• Ability to communicate effectively, both in writing and orally.

• Ability to establish and maintain effective working relationships with employees at all levels throughout the institution.

• Outstanding customer service skills.

• Strong clinical assessment and care coordination skills.

• Ability to build trusting relationships with patients and families.

• Knowledge of community resources and social determinants of health.

• Excellent communication and interdisciplinary collaboration skills.

• Ability to prioritize and manage multiple high-risk patients.

• Ability to analyze clinical information and support quality outcomes.

• Commitment to patient-centered, whole-person care.

• Ability to effectively communicate at all levels, to include physicians, leadership, and staff within the various affiliate organizations (UCH, Children's Colorado, CU Medicine, CU SOM).

• Ability to work within large, complex healthcare systems.

• Ability to analyze and interpret data.

How to Apply:

For full consideration, please submit the following document(s):

1. A letter of interest describing relevant job experiences as they relate to listed job qualifications and interest in the position.

2. Curriculum vitae / Resume

3. Three to five professional references, including name, address, phone number (mobile number if appropriate), and email address.

Questions should be directed to: Megan Dohn, megan.dohn@cuanschutz.edu

Screening of Applications Begins:

Immediately and continues until position is filled. For best consideration, apply by August 1^st, 2026.

Anticipated Pay Range:

The starting salary range (or hiring range) for this position has been established as $83,794 - $95,000.

The above salary range (or hiring range) represents the University's good faith and reasonable estimate of the range of possible compensation at the time of posting. This position may be eligible for overtime compensation, depending on the level.

Your total compensation goes beyond the number on your paycheck. The University of Colorado provides generous leave, health plans and retirement contributions that add to your bottom line.

Total Compensation Calculator

Equal Employment Opportunity Statement:

CU is an Equal Opportunity Employer and complies with all applicable federal, state, and local laws governing nondiscrimination in employment. We are committed to creating a workplace where all individuals are treated with respect and dignity, and we encourage individuals from all backgrounds to apply, including protected veterans and individuals with disabilities.

ADA Statement:

The University will provide reasonable accommodations to applicants with disabilities throughout the employment application process. To request an accommodation pursuant to the Americans with Disabilities Act, please contact the Human Resources ADA Coordinator at hr.adacoordinator@cuanschutz.edu

Background Check Statement:

The University of Colorado Anschutz is dedicated to ensuring a safe and secure environment for our faculty, staff, students and visitors. To assist in achieving that goal, we conduct background investigations for all prospective employees.

Vaccination Statement:

CU Anschutz strongly encourages vaccination against the COVID-19 virus and other vaccine preventable diseases. If you work, visit, or volunteer in healthcare facilities or clinics operated by our affiliated hospital or clinical partners or by CU Anschutz, you will be required to comply with the vaccination and medical surveillance policies of the facilities or clinics where you work, visit, or volunteer, respectively. In addition, if you work in certain research areas or perform certain safety sensitive job duties, you must enroll in the occupational health medical surveillance program.