Nurse Case Manager II
About The Position
The Nurse Case Manager II provides 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 member health care across the care continuum. Duties are performed telephonically or on-site, including at hospitals for discharge planning. The position is primarily virtual, with in-person training sessions required. Candidates must be within reasonable commuting distance of the posting location unless a legally required accommodation applies; alternate locations may be considered for candidates who live within commuting distance of an office. The listed shift is 11:30 AM to 8:00 PM Eastern Time. The anticipated job posting end date is November 18, 2026.
Requirements
- 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 is required when providing services in multiple states.
Nice To Haves
- Certification as a Case Manager.
- Experience as a Case Manager.
- Bachelor of Science degree in a health-related field.
Responsibilities
- Ensure members have access to services appropriate to their health needs.
- Conduct assessments to identify individual needs and establish 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 care management treatment plan development.
- Negotiate reimbursement rates, as applicable.
- Assist in resolving provider, claims, or service issues.
- Assist with development of utilization and care management policies and procedures.
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 insurance.
- Dental insurance.
- Vision insurance.
- Short- and long-term disability benefits.
- 401(k) matching.
- 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
