RN Case Manager

EXL • United States,

10h • $75,000 - $95,000 • Remote

About The Position

The RN Case Manager performs comprehensive assessment, care planning, implementation, monitoring, and evaluation through telephone contact and digital outreach. The role helps beneficiaries regain optimum health or improve functional capability, supports effective self-care management, and promotes access to healthcare services and community resources. The position is remote/work from home, with travel of up to 5% annually for team meetings and limited client onsite engagements.

The Case Manager works directly with beneficiaries, their families or significant others, physicians, other healthcare providers, multidisciplinary teams, and community resources. The role advocates for beneficiaries and supports informed decision-making, self-determination, self-care, and continuity of care. It also requires accurate and timely documentation, compliance with professional standards and applicable regulations including HIPAA, ongoing professional development, and maintaining required nursing licensure and certifications.

Requirements

• Current, unrestricted Registered Nurse license in the state of residence and ability to obtain multi-state licensure.
• United States citizenship.
• Ability to obtain the required Security Clearance.
• Associate or bachelor's degree in nursing from an accredited institution.
• At least 5 years of clinical RN experience in direct patient care.
• Knowledge of case management practices and patient-centered care concepts.
• Proficiency in Microsoft Office, mobile technologies, and navigating multiple applications.
• Ability to adapt to changing priorities.

Nice To Haves

• Current Department of Defense Security Clearance.
• Bachelor's degree in nursing.
• At least 1 year of prior case management experience.
• Case Management Certification; CCM is preferred.
• Experience working in an NCQA- and URAC-accredited case management program.
• Experience as a telephonic case manager at a health plan.
• Excellent organizational and prioritization skills.
• Strong verbal, written, presentation, and interpersonal communication skills.
• Ability to work independently and collaboratively.
• Critical thinking and clinical problem-solving skills.
• Appreciation for cultural diversity and health and digital literacy issues.
• Professional demeanor and excellent customer service skills.
• Ability to work independently in a home office environment.

Responsibilities

• Conduct comprehensive beneficiary assessments and analyze findings to identify and prioritize clinical, psychosocial, and behavioral concerns and potential gaps in care.
• Develop and document individualized case management care plans in collaboration with beneficiaries, their families or significant others, physicians, and other healthcare providers.
• Document identified issues, individualized short- and long-term goals, evidence-based interventions, collaborative approaches and resources, anticipated time frames, and barriers to achieving goals.
• Coordinate and implement care plan activities to support benefits coverage, continuity of care, and integration of services across care transitions.
• Collaborate and communicate with beneficiaries, families, significant others, physicians, and other healthcare providers to achieve care plan goals.
• Monitor and evaluate care plans on a scheduled basis, determine whether desired outcomes and goals have been met, and revise plans as needed with beneficiaries and the healthcare team.
• Initiate care conferences with the Medical Director and/or multidisciplinary care team to discuss challenging cases and obtain clinical opinion or consultation.
• Advocate for beneficiaries by promoting self-determination, informed and shared decision-making, autonomy, and self-advocacy.
• Educate and support beneficiaries to reinforce self-care management, facilitate access to care, and promote optimal health outcomes.
• Identify benefit-related, educational, and healthcare resources and coordinate care with community-based programs and services.
• Apply comprehensive case management principles, patient-centered and culturally sensitive care coordination, and management of complex conditions.
• Collaborate with beneficiaries and their support systems, caregivers, providers, multidisciplinary teams, and healthcare and community resources throughout the case management process.
• Perform case management activities within the scope of professional licensure.
• Participate in ongoing training and professional development to maintain case management competencies and knowledge of evidence-based practices.
• Maintain continuing education units as required by applicable State Boards of Nursing and required certifications, and obtain and maintain additional licenses as needed for business requirements.
• Conduct case management activities in accordance with professional standards of practice and applicable policies and procedures.
• Participate in regular team conferences and meetings.
• Document clinical information and data accurately, concisely, and on time in accordance with applicable standards of practice.
• Maintain knowledge of and comply with applicable federal and state regulations, including patient confidentiality, release of information, HIPAA, privacy, and security requirements.

Benefits

• Mentoring program that assigns junior-level employees a senior-level professional as an advisor.
• Guidance and coaching.
• Opportunities for professional growth and development.
• Opportunity to work closely with experienced healthcare consultants.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree