Nurse Case Mgr II (RN)
About The Position
The Nurse Case Mgr II (RN) provides care management within the scope of licensure for members with complex and chronic care needs. The role involves screening, assessing, stratifying risk, planning, implementing care coordination, following up, supporting transitions and post-transition communication, and evaluating member care. The care model aims to optimize members’ healthcare across the care continuum through interventions that improve clinical outcomes, productivity, and quality of life. This is a 100% telephonic outbound-calling program. The position is described as virtual full-time, with in-person training sessions required. Alternate locations may be considered for candidates within commuting distance of an office; candidates outside a reasonable commuting distance will not be considered unless an accommodation is granted as required by law. The work schedule is Monday through Friday, 9:00 a.m. to 5:30 p.m. Pacific or Mountain time, with two evening shifts each week from 11:30 a.m. to 8:00 p.m. Pacific or Mountain time. Multi-state RN licensure is required upon hire to serve members in multiple states.
Requirements
- A bachelor’s degree in a health-related field and at least five years of clinical experience, or an equivalent combination of education and experience.
- Current, unrestricted RN license in applicable state(s).
- Multi-state RN licensure upon hire, as services are provided in multiple states.
Nice To Haves
- Active California RN license.
- At least two years of direct case management experience.
- Case Manager certification (CCM).
- Telephonic and/or virtual nursing experience.
- Managed care experience.
- At least two years of experience in an acute care setting.
- Experience with the Microsoft Office suite and/or ability to learn new computer programs, systems, and software quickly.
- Ability to speak and type at the same time.
Responsibilities
- Ensure members have access to services appropriate to their health needs.
- Conduct assessments to identify individual needs and develop care management plans addressing objectives and goals identified during assessment.
- Assist in 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 the effectiveness of care management plans and modify them as necessary.
- Interface with Medical Directors and other health professionals to develop care management treatment plans.
- 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 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
