Nurse Case Mgr II (US)
About The Position
The Nurse Case Manager II 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 to optimize members’ health care across the care continuum. Duties are performed telephonically or on-site, such as at hospitals for discharge planning. The position is open to candidates in Kentucky. It is primarily virtual full-time, with in-person training sessions required. Alternate locations may be considered for candidates within commuting distance of an office; candidates outside a reasonable commuting distance generally will not be considered unless an accommodation is granted as required by law. Work hours are 11:30 a.m. to 8:00 p.m.
Requirements
- A bachelor’s degree in a health-related field and at least 5 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.
- A bachelor’s degree in a health- or human-services-related field.
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 to develop care management treatment plans.
- Negotiate reimbursement rates, as applicable.
- Assist with problem solving related to providers, claims, or service issues.
- Assist with the development of utilization and care management policies and procedures.
Benefits
- 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) with company 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
