Nurse Case Mgr I (RN)
About The Position
The Nurse Case Mgr I (RN) 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 designed to optimize member health care across the care continuum. Duties are performed telephonically. The position is virtual full-time, except for required in-person training sessions. Candidates generally must reside within a reasonable commuting distance of an office, unless an accommodation is granted as required by law. The regular schedule is Monday through Friday, 9:00 a.m. to 5:30 p.m. EST, with two to four late evening shifts per month, 11:30 a.m. to 8:00 p.m. EST.
Requirements
- A BA/BS in a health-related field and at least 3 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 upon hire.
Nice To Haves
- Certification as a Case Manager.
- Previous case management experience.
- Home health experience.
- Utilization management experience.
- Hospital discharge planning experience.
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 care plan effectiveness and modify plans as necessary.
- Interface with Medical Directors and Physician Advisors on the development of care management treatment plans.
- Assist with problem-solving involving providers, claims, or service issues.
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) 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
Entry Level
