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 primarily virtual, with required in-person training sessions; alternate locations may be considered for candidates within commuting distance of an office. This role serves members in different states and requires applicable multi-state licensure.
Requirements
- Current, unrestricted RN license in the applicable state.
- Multi-state licensure is required when providing services in multiple states.
- Ability to manage, review, and respond to emails and instant messages in a timely fashion.
Nice To Haves
- Case Management experience.
- Utilization Management experience.
- Certification as a Case Manager.
- At least 2 years of experience in an acute care setting.
- Experience with Microsoft Office and/or ability to learn new computer programs, systems, and software quickly.
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.
- 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 related to providers, claims, or service issues.
- Assist with development of utilization and care management policies and procedures.
Benefits
- Comprehensive benefits package, subject to eligibility requirements.
- Incentive and recognition programs.
- Equity stock purchase.
- 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
