Nurse Case Mgr II (US)
About The Position
The Telephonic NICU 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 and may also be performed on-site, such as at hospitals for discharge planning. This is a full-time virtual role with required in-person training sessions. Candidates generally must live within a reasonable commuting distance of an office, though alternate locations may be considered if the candidate is within commuting distance. The position is scheduled Monday through Friday, 8:00 a.m. to 4:30 p.m. Eastern Time. The role is classified as non-management exempt.
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 if providing services in multiple states.
- Ability to talk and type simultaneously.
- Critical-thinking skills when interacting with members.
- Experience with Microsoft Office and/or ability to learn new computer programs, systems, and software quickly.
- Ability to manage, review, and respond to email and instant messages in a timely manner.
Nice To Haves
- NICU experience strongly preferred.
- Certification as a Case Manager.
- Managed care experience.
- Knowledge of health insurance and benefits, medical management processes, care management, and utilization review management.
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 the effectiveness of care management plans and modify them as necessary.
- Interface with Medical Directors and Physician Advisors to develop care management treatment plans.
- Negotiate reimbursement rates, as applicable.
- Help resolve provider, claims, or service issues.
- Assist with developing utilization and care management policies and procedures.
- Perform care management 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) matching.
- Life insurance.
- Wellness programs.
- Financial education resources.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
