Telephonic Nurse Case Manager II
About The Position
The Telephonic Nurse Case Manager II provides 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 intended to optimize member health care across the care continuum, and performs duties telephonically. This role enables associates to work virtually full-time, except for required in-person training sessions. Alternate locations may be considered for candidates within commuting distance of an office; candidates outside a reasonable commuting distance from the posting locations are not considered unless an accommodation is granted as required by law. The position serves members in multiple states and requires multi-state licensure. Hours are Monday through Friday, either 9:00 a.m.–5:30 p.m. EST or 9:30 a.m.–6:00 p.m. EST, with one late evening shift of 11:30 a.m.–8:00 p.m. EST. An online pre-employment skills assessment is required. Candidates who meet minimum requirements will receive instructions by email and must complete the assessment within 48 hours of receipt and meet the criteria. The position is classified as Non-Management Exempt.
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 licensure if providing services in multiple states.
- Ability to talk and type simultaneously.
- Critical thinking skills when interacting with members.
- Ability to manage, review, and respond to emails and instant messages in a timely manner.
- Completion of the required online pre-employment skills assessment within 48 hours of receiving instructions, and meeting the assessment criteria.
Nice To Haves
- Case Manager certification.
- Bachelor's degree in a health- or human-services-related field.
- At least 2 years of experience in an acute care setting.
- Managed care experience.
- Experience with Microsoft Office and/or ability to learn new computer programs, systems, and software quickly.
Responsibilities
- Ensure members have access to services appropriate to their health needs.
- Conduct assessments to identify individual needs and develop care management plans with objectives and goals.
- Implement care plans by facilitating authorizations and referrals within the benefits structure or through extra-contractual arrangements.
- Coordinate internal and external resources to meet identified needs.
- Monitor and evaluate care plan effectiveness and modify plans as necessary.
- Interface with Medical Directors and Physician Advisors to develop care management treatment plans.
- Negotiate reimbursement rates, as applicable.
- Assist in resolving provider, 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 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
