Nurse Case Mgr II (US)
About The Position
The 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 intended to optimize member health care across the care continuum. Duties are performed telephonically or on-site, such as at hospitals for discharge planning. This position is virtual full-time, except for required in-person training sessions. Candidates must reside in Kentucky. Alternate locations may be considered for candidates within commuting distance of an office; candidates outside a reasonable commuting distance from the posting location will not be considered unless an accommodation is granted as required by law. Hours are 11:30 a.m. to 8:00 p.m.
Requirements
- Bachelor of Arts or Bachelor of Science degree in a health-related field and a minimum of 5 years of clinical experience, or an equivalent combination of education and experience.
- Current, unrestricted RN license in applicable state(s).
- Multi-state licensure is required if providing services in multiple states.
Nice To Haves
- Certification as a Case Manager.
- Bachelor of Science degree in a health- or human-services-related field.
Responsibilities
- Ensure members have access to services appropriate to their health needs.
- Conduct assessments to identify individual needs and develop specific care management plans addressing objectives and goals identified during assessment.
- 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 plan effectiveness and modify plans 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 provider, claims, or service issues.
- Assist with development of 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 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
