Nurse Case Mgr II (RN)
About The Position
The Nurse Case Mgr II (RN) provides care management, within the scope of licensure, to members with complex and chronic care needs. Care management includes screening, assessing, stratifying risk, planning and implementing care coordination, following up, coordinating transitions and post-transition communication, and evaluating member needs and outcomes. The care model aims to optimize member health 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 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 are not considered unless an accommodation is granted. The 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. The role serves members in multiple states and requires multi-state RN licensure upon hire.
Requirements
- 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 applicable state(s).
- Multi-state RN licensure required upon hire to provide services in multiple states.
Nice To Haves
- Active California RN license is highly preferred.
- At least 2 years of direct case management experience.
- Case Manager certification (CCM) preferred.
- Telephonic and/or virtual nursing experience.
- Managed care experience.
- At least 2 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 the objectives and goals identified during assessment.
- Facilitate authorizations and referrals as appropriate 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 needed.
- Interface with Medical Directors and other health professionals to develop care management treatment plans.
- Assist with problem-solving involving providers, claims, or service issues.
- Assist with developing 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 company match.
- Stock purchase plan.
- Life insurance.
- Wellness programs.
- Financial education resources.
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
What This Job Offers
Job Type
Full-time
Career Level
Mid Level
