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 member health care across the care continuum. Duties are performed telephonically or on-site, such as at hospitals for discharge planning. The role is primarily virtual, with required in-person training sessions. Candidates must live within a reasonable commuting distance of a posting location unless an accommodation is granted. The regular schedule is Monday through Friday, 8:00 a.m. to 4:30 p.m. Eastern Time, with two to three late evenings per month from 11:30 a.m. to 8:00 p.m.
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 if providing services in multiple states.
Nice To Haves
- Certification as a Case Manager.
- 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 a care management plan 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 the development of care management treatment plans.
- Negotiate reimbursement rates, as applicable.
- Assist with problem solving related to providers, claims, or service issues.
- Assist with developing utilization and care management policies and procedures.
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, dental, and vision benefits.
- 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
Mid Level
