Nurse Case Manager I
About The Position
The Telephonic 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. The position enables associates to work virtually full-time, except for required in-person training sessions. Candidates must be within reasonable commuting distance of a posting location unless an accommodation is granted. The role serves members in multiple states and requires multi-state licensure. The schedule is Monday through Friday, 9:00 a.m. to 5:30 p.m., with one or two late evenings from 11:30 a.m. to 8:00 p.m., depending on time zone.
Requirements
- A BA/BS 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 when providing services in multiple states.
Nice To Haves
- Certification as a Case Manager.
Responsibilities
- Ensure members have access to services appropriate to their health needs.
- Conduct assessments to identify individual needs and develop specific 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 reimbursement rates, as applicable.
- Assist with problem-solving involving providers, claims, or service issues.
Benefits
- Comprehensive benefits package, subject to eligibility requirements.
- Incentive and recognition programs.
- Equity stock purchase and 401(k) contribution.
- Merit increases.
- Paid holidays and 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
Mid Level
