Nurse Case Mgr I (RN)
About The Position
The Nurse Case Manager I (RN) performs telephonic care management within the scope of licensure for members with complex and chronic care needs. The role assesses, develops, implements, coordinates, monitors, and evaluates care plans intended to optimize member health care across the care continuum. The position is virtual full-time, with required in-person training sessions. Candidates generally must live within a reasonable commuting distance of the posting location unless an accommodation is granted. The regular schedule is Monday through Friday, 9:00 a.m. to 5:30 p.m. Eastern Time, with two to four late evening shifts per month from 11:30 a.m. to 8:00 p.m. Eastern Time. The listed salary range for New York is $70,560 to $105,840. The role is classified as non-management exempt.
Requirements
- A bachelor's degree in a health-related field and at least 3 years of clinical experience, or an equivalent combination of education and experience.
- Current, unrestricted RN license in applicable state(s).
- Multi-state licensure is required upon hire.
Nice To Haves
- Case Manager certification is preferred.
- Previous case management experience.
- Home health, utilization management, and/or hospital discharge planning experience is a plus.
Responsibilities
- Ensure members have access to services appropriate to their health needs.
- Conduct assessments to identify individual needs and develop care management plans with objectives and goals.
- Implement care plans by facilitating authorizations and referrals within the benefits structure or through extra-contractual arrangements, as appropriate.
- Coordinate internal and external resources to meet identified needs.
- Monitor and evaluate the effectiveness of care management plans and modify them as necessary.
- Interface with Medical Directors and Physician Advisors on developing care management treatment plans.
- Assist with problem-solving related to providers, claims, or service issues.
Benefits
- Comprehensive benefits package, subject to eligibility requirements.
- Incentive and recognition programs.
- Equity stock purchase plan.
- 401(k) contribution.
- Merit increases.
- Paid holidays.
- Paid time off.
- Incentive bonus programs, unless covered by a collective bargaining agreement.
- Medical insurance.
- Dental insurance.
- Vision insurance.
- Short- and long-term disability benefits.
- 401(k) matching.
- Life insurance.
- Wellness programs.
- Financial education resources.
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
