Case Manager RN

Health Plans Inc• US,

8d•$85,000 - $95,000•Onsite

About The Position

HPI is a unique, respected industry leader with over 44 years of experience, known for innovation and adaptability. As a third-party administrator, HPI offers a suite of health and benefit solutions to employers. Joining HPI means contributing to ideas that make a real difference for employers and employees nationwide. The company fosters a supportive and inclusive work environment where innovation thrives, investing in team growth and well-being to ensure exceptional service. Our Case Managers play a vital role in guiding individuals and their families through the healthcare system, using a collaborative process focused on assessment, planning, facilitation, care coordination, evaluation, and advocacy. The goal is to meet comprehensive health needs while promoting patient safety, quality of care, and cost-effective outcomes. Case Managers serve as trusted partners, helping members understand their conditions, access resources, and navigate care with confidence.

Requirements

An active professional licensure as a Registered Nurse (RN) in MA, ME or NH (required)
3+ years of clinical experience (required)
Competency in Windows-based computers (required)

Nice To Haves

3+ years Discharge Planning and/or Case Management experience
Familiarity with URAC standards, Department of Labor, state/federal regulations

Responsibilities

Conduct utilization management using standardized clinical criteria
Consult with Physician Reviewers and other experts to determine appropriateness of care
Develop individualized case management plans and identify quality of care issues
Telephonically assess members to ensure safe transition to next level of care upon discharge
Determine and document quantifiable outcomes, including avoidable and actual dollar savings
Continually educate the patient/family to promote self-management and self-advocacy
Research available community resources and alternative funding sources as appropriate