Nurse Case Manager 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 intended to optimize members’ health care across the care continuum. Duties are performed telephonically or on-site, including at hospitals for discharge planning. The position is based in one of the listed locations and 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 as required by law. Standard working hours are Monday through Friday.
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 the applicable state or states.
- Multi-state licensure is required if providing services in multiple states.
Nice To Haves
- Certification as a Case Manager.
- Previous experience with utilization review and/or prior authorization.
- Clinical case management experience in an inpatient or outpatient setting.
- Critical thinking skills when interacting with members.
- Experience with Microsoft Office and/or the ability to learn new computer programs, systems, and software quickly.
- Ability to manage, review, and respond to emails and instant messages in a timely fashion.
- Excellent collaboration, communication, and teamwork skills.
Responsibilities
- Ensure members have access to services appropriate to their health needs.
- Conduct assessments to identify individual needs and develop care management plans addressing assessment 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.
- Negotiate rates of reimbursement, as applicable.
- Assist in resolving provider, 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 benefits.
- Dental benefits.
- Vision benefits.
- Short- and long-term disability benefits.
- 401(k) with match.
- Stock purchase plan.
- Life insurance.
- Wellness programs.
- Financial education resources.
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
