Nurse Case Manager II
About The Position
The Nurse Case Manager II provides telephonic care management for members with complex and chronic care needs, working within the scope of licensure. The role assesses, develops, implements, coordinates, monitors, and evaluates care plans intended to optimize member health across the care continuum. The position is based in Georgia and is described as virtually full-time, with required in-person training sessions. Candidates must live within a reasonable commuting distance of a posting location unless an accommodation is granted as required by law. The regular schedule is Monday through Friday, 9:00 a.m. to 5:30 p.m., with one 11:30 a.m. to 8:00 p.m. shift each week. The position is classified as non-management exempt and belongs to the Licensed Nurse job family.
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.
- For URAC-accredited areas: a bachelor's degree and at least 5 years of clinical care experience, or an equivalent combination of education and experience; current and active RN license in applicable state(s); and multi-state licensure if providing services in multiple states.
Nice To Haves
- Certification as a Case Manager is preferred.
- For URAC-accredited areas, 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 with objectives and goals.
- 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 management plans and modify them as necessary.
- Interface with Medical Directors and Physician Advisors on the development of care management treatment plans.
- Negotiate reimbursement rates, as applicable.
- Assist in resolving provider, claims, or service issues.
- Assist with developing 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 benefits
- Dental insurance
- Vision insurance
- Short- and long-term disability benefits
- 401(k) with 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
