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, including at hospitals for discharge planning. This is a virtual role that enables associates to work virtually full-time, except for required in-person training sessions. Candidates must reside within a reasonable commuting distance from a posting location unless an accommodation is granted as required by law. Work hours are generally 8:00 a.m. to 4:30 p.m., with two 11:30 a.m. to 8:00 p.m. shifts per month.
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 if providing services in multiple states.
Nice To Haves
- Certification as a Case Manager.
- Residing in the Eastern or Central time zone.
- Telephonic coaching experience.
- For URAC-accredited areas, a bachelor's degree in a health or human services-related field and Case Manager certification are preferred.
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.
- Coordinate internal and external resources to meet identified needs.
- Monitor and evaluate care plan effectiveness and modify plans as necessary.
- Interface with Medical Directors and Physician Advisors on developing care management treatment plans.
- Negotiate rates of reimbursement, as applicable.
- 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.
- 401(k) contribution.
- Merit increases.
- Paid holidays.
- Paid Time Off.
- Incentive bonus programs, unless covered by a collective bargaining agreement.
- Medical, dental, and vision benefits.
- 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
