Nurse Case Mgr
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. The position is virtually full-time, except for required in-person training sessions; candidates must reside within reasonable commuting distance of a posting location unless an accommodation is granted as required by law. This role serves members in different states and requires multistate licensure. The stated schedule is Monday through Friday, 9:30 a.m. to 6:30 p.m. EST.
Requirements
- Current, unrestricted RN license in the applicable state.
- Multistate licensure is required when providing services in multiple states; this position serves members in different states.
- At least 2 years of experience in an acute care setting.
- Ability to manage, review, and respond to emails and instant messages in a timely manner.
- Ability to use Microsoft Office and/or quickly learn new computer programs, systems, and software.
Nice To Haves
- Case management experience.
- Utilization management experience.
- Certification as a Case Manager.
Responsibilities
- Ensure members have access to services appropriate to their health needs.
- Conduct assessments to identify individual needs and develop specific 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 on the development of care management treatment plans.
- Negotiate reimbursement rates, as applicable.
- Assist with problem-solving involving 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 and 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) 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
Education Level
No Education Listed
