Complex Case Management Nurse
About The Position
You will educate members on improving health outcomes, assist with transitions from care settings, participate in process improvement and other pilot programs as they arise, and work with support teams to ensure exceptional care for our members. You will report into the Associate Director, Clinical. Work Location: This is a remote position, open to candidates who reside in: Alabama; Arizona; Arkansas; Colorado; Connecticut; District of Columbia; Florida; Georgia; Idaho; Illinois; Indiana; Iowa; Kansas; Kentucky; Maine; Maryland; Massachusetts; Michigan; Minnesota; Missouri; Nevada; New Hampshire; New Jersey; New Mexico; North Carolina; Ohio; Oregon; Pennsylvania; Rhode Island; South Carolina; Tennessee; Texas; Utah; Vermont; or Virginia. While your daily work will be completed from your home office, occasional travel may be required for team meetings and company events. #LI-Remote
Requirements
- Active, unrestricted RN licensure from the United States in [state], OR, active compact multistate unrestricted RN license
- Ability to obtain additional state licenses to meet business needs
- 2+ years of clinical experience to include payer, hospital, outpatient or community based care management
- 1+ years of experience in Care Coordination and Navigation
Nice To Haves
- CCM Certification
- NCQA knowledge and accreditation experience
- Bilingual in spanish and or creole reading, writing, speaking
- BSN
- Working knowledge of Milliman Guidelines
Responsibilities
- Assist in the coordination of care across a variety of settings (inpatient, outpatient, post acute, ER, home care)
- Actively reach out to members undergoing difficult health challenges and develop care plans
- Proactively reach out to hospital case managers to assist with discharge planning
- Communicate with members via phone or secure messaging to provide education on health conditions, new medications, and procedures
- Ensure compliance with all CCM NCQA standards in day to day practice and workflows.
- Compliance with all applicable laws and regulations
- Other duties as assigned
Benefits
- medical, dental, and vision benefits
- 11 paid holidays
- paid sick time
- paid parental leave
- 401(k) plan participation
- life and disability insurance
- paid wellness time and reimbursements
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
