Nurse Case Manager II
About The Position
The Nurse Case Manager II provides telephonic 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. The position is based in Georgia and is virtual full-time except for required in-person training sessions. Candidates must be within a reasonable commuting distance of the posting location unless an accommodation is granted. 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.
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 the applicable state(s).
- Multi-state licensure is required when providing services in multiple states.
Nice To Haves
- Certification as a Case Manager is preferred.
- For URAC-accredited areas, a bachelor's degree in a health or human services-related field is preferred.
Responsibilities
- Ensure member 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.
- 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.
- Assist with problem solving involving providers, 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 benefits
- Vision benefits
- Short- and long-term disability benefits
- 401(k) with company 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
