Nurse Case Mgr I
About The Position
The Nurse Case Manager I performs 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 designed to optimize member health care across the care continuum. Duties are performed telephonically or on-site, such as at hospitals for discharge planning. The position is primarily virtual full-time, except for required in-person training sessions. Candidates generally must reside within a reasonable commuting distance of the applicable office location unless an accommodation is granted as required by law. Alternate locations may be considered for candidates within commuting distance of an office.
Requirements
- Bachelor’s degree in a health-related field and a minimum of 3 years of clinical experience, or an equivalent combination of education and experience.
- Current, unrestricted RN license in applicable state(s); current and active RN license is required in URAC-accredited areas.
- Multi-state licensure is required if providing services in multiple states.
- For URAC-accredited areas, a bachelor’s degree and 3 years of clinical care experience are required, or an equivalent combination of education and experience.
Nice To Haves
- Certification as a Case Manager.
- Experience with home health or Med-Surg.
Responsibilities
- Ensures member access to services appropriate to their health needs.
- Conducts assessments to identify individual needs and develop a specific care management plan addressing objectives and goals identified during assessment.
- Coordinates internal and external resources to meet identified needs.
- Monitors and evaluates the effectiveness of care management plans and modifies them as necessary.
- Interfaces with Medical Directors and Physician Advisors on the development of care management treatment plans.
- Negotiates rates of reimbursement, as applicable.
- Assists in problem solving with providers, claims, or service issues.
- Performs care management duties telephonically or on-site, including at hospitals for discharge planning.
Benefits
- Comprehensive benefits package, subject to eligibility requirements.
- Incentive and recognition programs.
- Equity stock purchase.
- 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) with match.
- Stock purchase plan.
- Life insurance.
- Wellness programs.
- Financial education resources.
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
