Nurse Case Mgr I (US)
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 enables associates to work virtually full-time, except for required in-person training sessions. Alternate locations may be considered for candidates within commuting distance of an office; candidates outside a reasonable commuting distance from the posting locations will not be considered unless an accommodation is granted as required by law.
Requirements
- 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 if providing services in multiple states.
Nice To Haves
- Certification as a Case Manager is preferred.
- A BS in a health- or human-services-related field is preferred.
Responsibilities
- Ensure members have access to services appropriate to their health needs.
- Conduct assessments to identify individual needs and develop care management plans addressing objectives and goals identified during assessment.
- 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 care-plan effectiveness and modify plans as necessary.
- Interface with Medical Directors and Physician Advisors on the development of care management treatment plans.
- Negotiate reimbursement rates, as applicable.
- Assist with problem-solving related to providers, claims, or service issues.
- Perform duties telephonically or on-site, including hospital discharge planning.
Benefits
- Comprehensive benefits package, subject to eligibility requirements.
- Incentive and recognition programs.
- Equity stock purchase plan.
- 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) match.
- Life insurance.
- Wellness programs.
- Financial education resources.
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
