Duet
RN Care Manager, Population Health Programs
4mo ago
85000 –110000 USD / yearUSASeniorRemotemedication reconciliationchronic condition management
Registered Nurse Care Manager delivering longitudinal care and leading program development for Medicare care management.
Requirements
- Active RN license (New York State)
- 3+ years of clinical nursing experience (primary care, care management, population health, or related field preferred)
- Experience working with Medicare populations strongly preferred
- Demonstrated ability to build or improve clinical workflows
- Strong operational mindset with comfort in ambiguity and early-stage environments
- Familiarity with value-based care models (ACO, MSSP, APCM, CCM)
- Strong care coordination, documentation, and patient engagement skills
- Comfortable working in a hybrid NYC-based role with in-person collaboration
- Knowledge of social determinants of health and community-based resources
Other
- About Duet : Duet is on a mission to transform primary care by empowering nurse practitioners (NPs) to own and operate their practices. By providing NPs with tailored products and services within a supportive setting, Duet is building the nation’s largest network of NP-owned practices, driving better outcomes for patients and communities.
- The Registered Nurse Care Manager (RNCM) will be the founding clinical hire for our Medicare care management programs. This is an opportunity to help design, operationalize, and scale a best-in-class value-based care management model from the ground up.
- The RNCM will deliver longitudinal, relationship-based care to Medicare beneficiaries while also partnering closely with leadership to build workflows, define best practices, and shape the future of the program. This role blends hands-on clinical care management with operational leadership and program development.
- This position is ideal for an RN who is entrepreneurial, systems-oriented, and excited to build a care management playbook.
- Conduct comprehensive assessments for Medicare beneficiaries, including medical, behavioral, and social needs
- Develop and manage individualized care plans aligned with evidence-based guidelines
- Provide chronic condition management (e.g., diabetes, CHF, COPD, hypertension)
- Perform medication reconciliation and adherence support
- Deliver patient education, coaching, and self-management support
- Coordinate care across primary care, specialists, hospitals, post-acute, and community resources
- Manage transitions of care following ED visits or hospitalizations
- Close care gaps related to preventive care, screenings, and quality measures
- Design and refine care management workflows from enrollment through ongoing engagement
- Build documentation standards to support APCM and other care management billing programs
- Partner with analytics and operations to define caseload models, outreach triggers, and performance metrics
- Identify gaps in process and implement scalable solutions
- Help select and optimize care management tools and EHR workflows
- Contribute to hiring plans, onboarding materials, and training content as the team grows
- Serve as a clinical thought partner to leadership on ACO and value-based strategy
- Support ACO quality and utilization goals (HEDIS, STARs, TCM, etc.)
- Document care management activities to support billing (e.g., APCM / care management programs)
- Identify opportunities to reduce avoidable ED visits and hospital admissions
- Partner with operations and analytics teams to track outcomes and performance
- Serve as a core member of the interdisciplinary care team
- Communicate regularly with patients, caregivers, and providers via phone and video settings
- Escalate clinical concerns appropriately and support clinical decision-making
- Builder-minded RN leaders who are excited to design workflows — not just follow them
- Clinicians who think in systems, seeing both the individual patient journey and the operational engine behind it
- Thoughtful relationship-builders who get energy from helping others succeed High EQ, low ego, and a bias toward action
- Self-starters who love learning, growing, and wearing multiple hats
- People who bring joy, humility, and hustle to their work
- This role is hybrid, based in NYC.
- Salary range: $85K-$110K