Telephonic Nurse Case Manager I
About The Position
The Telephonic Nurse Case Manager I 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 to optimize member health care across the care continuum, performing duties telephonically. The position serves members in multiple states and requires multi-state licensure. The role is primarily virtual, with required in-person training sessions; alternate locations may be considered for candidates within commuting distance of an office. The schedule is Monday through Friday, 9:00 a.m. to 5:30 p.m., with 2–4 evenings per month from 11:30 a.m. to 8:00 p.m.
Requirements
- Bachelor’s degree 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 the applicable state(s).
- Multi-state licensure is required when providing services in multiple states.
Nice To Haves
- Certification as a Case Manager.
- Oncology experience.
- Case Management experience.
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.
- Implement care plans by 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 Physician Advisors on the development of care management treatment plans.
- Negotiate reimbursement rates, as applicable.
- Assist with problem-solving related to providers, claims, or service issues.
Benefits
- Comprehensive benefits package, subject to eligibility requirements.
- Incentive and recognition programs.
- Equity stock purchase plan.
- 401(k) contribution.
- Merit increases.
- Paid holidays.
- Paid Time Off.
- Incentive bonus programs, unless covered by a collective bargaining agreement.
- Medical insurance.
- Dental insurance.
- Vision insurance.
- Short- and long-term disability benefits.
- 401(k) matching.
- Life insurance.
- Wellness programs.
- Financial education resources.
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
