Nurse Case Manager Jobs

About The Position

Requirements

• A 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).
• Multistate licensure if providing services in multiple states.

Nice To Haves

• Certification as a Case Manager.
• A bachelor's degree in a health- or human-services-related field.
• Active Registered Nurse Compact License.

Responsibilities

• Ensure members have access to services appropriate to their health needs.
• Conduct assessments to identify individual needs and develop specific 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 needed.
• Interface with Medical Directors and Physician Advisors on the development of care management treatment plans.
• Negotiate reimbursement rates, as applicable.
• Assist in resolving provider, claims, or service issues.
• Assist with the development of 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 insurance.
• Dental insurance.
• Vision insurance.
• Short- and long-term disability benefits.
• 401(k) match.
• Stock purchase plan.
• Life insurance.
• Wellness programs.
• Financial education resources.