Nurse Case Manager I

RH Wine & Co LLC • St. Charles, IL

10h • Remote

About The Position

We are looking for a fully remote Registered Nurse for our Nurse Case Manager position. Candidate will need 1+ years of case management experience in which there is a return to work focus and two years full-time equivalent of direct clinical care to the consumer. This position will be a part of a collaborative process of assessment, planning, facilitation, and advocacy for options and services to meet an individual's health and/or disability needs through communication and available resources to promote quality cost-effective outcomes. The position will primarily support short term disability and workers’ compensation with potential for group health benefits case management.

Requirements

• Current registered nurse (RN) License
• 2 years of clinical experience
• Excellent written and verbal communication skills
• Proven customer service skills
• Effective time management skills
• Overall computer proficiency including expertise in Microsoft Office Suite, especially Outlook, Word, and Excel
• Licensure or certification in a health or human services discipline that allows the professional to conduct an assessment independently as permitted within the scope of practice of the discipline.
• Two years full-time equivalent of direct clinical care to the consumer
• At least one of the following: Certification as a case manager from the URAC-approved list of certifications; or A bachelor’s or higher degree in a health or human services related field; or A current registered nurse (RN) license
• Willingness to obtain advanced certification, when eligible
• Willingness to obtain additional state licensure, as required by business needs.

Nice To Haves

• Advanced/board certification in case management
• Additional case management/utilization review experience will be considered

Responsibilities

• Conducts initial and ongoing assessments to identify patient status and individual needs; promotes client self-determination
• Assists in identifying appropriate providers and facilities throughout the continuum of services, while ensuring that available resources are being used in a timely and cost-effective manner in order to obtain optimum value for both the client and the reimbursement source.
• Utilizes appropriate resources and case management interventions to facilitate the case management plan and to allow for the individual’s optimum level of wellness and functional capability with quality cost-effective outcomes appropriate to health plan and workers’ compensation
• Develops a specific case management plan in collaboration with the consumer and members of the health care team with periodic updates. Identifies short term goals, long term goals, interventions to meet goals, resources to be utilized, timeframes for re-evaluations, and collaborative approaches to facilitate the case management plan
• Executes and documents specific case management activities and/or interventions that will lead to accomplishing the goals set forth in the case management plan
• Gathers sufficient information from all relevant sources and its documentation regarding the case management plan and it activities and/or services to enable the determination of the plan’s effectiveness
• Evaluates at appropriate intervals, determining and documenting the case management plan’s effectiveness in reaching desired outcomes and goals with modifications, as appropriate
• Measures and modifies the interventions to determine the outcomes of the case management involvement
• Implements care plan by facilitating authorizations and referrals, as appropriate, within benefit structure, contractual agreements or jurisdictional regulations; utilizing nationally accepted evidence based criteria as guidelines for treatment protocols
• Documents all contacts according to Best Practices, utilizing templates, as required
• Notifies claims personnel regarding anticipated surgeries, benefit exceptions, and other significant events that may require special handling
• Manages the disability durations proactively, utilizing nationally accepted evidence based criteria as guidelines for duration protocols in workers’ compensation and short term disability
• Collaborates and communicates effectively with patients/injured workers, providers, client, employers, and internal team members
• Performs triage intake functions with referrals and coordination of care needs specific to client instructions.
• Performs leave administration and short term disability management according to regulations, policies, and plan documents

Benefits

• Generous Time off. You'll start with 20 days of PTO, paid holidays, paid Birthday off
• Medical, dental, and vision coverage on day one of full-time employment, including telemedicine if you are on our medical plan
• 401k match
• Professional development support and a Linkedin Learning subscription
• Flexible time off with an encouraged time away to support a healthy work-life balance
• Life Insurance, Short term, and long-term disability on day one of full-time employment and paid for by IPMG
• Onsite fitness center and showers, in our St. Charles, IL HQ office

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level