Nurse Case Mgr II
About The Position
Nurse Case Manager II is responsible for care management within the scope of licensure for members with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum. Perform duties telephonically. This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Alternate locations may be considered if candidates reside within commuting distance from an office. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless accommodation is granted as required by law.
Requirements
- Current, unrestricted RN license in applicable state required.
- Multi-state licensure is required if this individual provides services in multiple states.
- Minimum 2 years’ experience in acute care setting.
- Experience with (Microsoft Office) and/or ability to learn new computer programs/systems/software quickly.
- Ability to manage, review and respond to emails/instant messages in a timely fashion.
- This position will service members in different states; therefore, Multi-State Licensure will be required.
Nice To Haves
- Case Management experience.
- Utilization Management experience.
- Certification as a Case Manager.
Responsibilities
- Ensures member access to services appropriate to their health needs.
- Conducts assessments to identify individual needs and a specific care management plan to address objectives and goals as identified during assessment.
- Implement care plan by facilitating authorizations/referrals as appropriate within benefits structure or through extra-contractual arrangements.
- Coordinates internal and external resources to meet identified needs.
- Monitors and evaluates effectiveness of the care management plan and modifies as necessary.
- Interfaces with Medical Directors and Physician Advisors on the development of care management treatment plans.
- Negotiate rates of reimbursement, as applicable.
- Assists in problem solving with providers, claims or service issues.
- Assists with development of utilization/care management policies and procedures.
Benefits
- merit increases
- paid holidays
- Paid Time Off
- incentive bonus programs
- medical
- dental
- vision
- 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
Mid Level
Education Level
High school or GED
