Nurse Case Manager

Role Overview

• Performing care management within the scope of licensure for members with complex and chronic care needs
• Assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum
• Conducting assessments to identify individual needs and a specific care management plan
• Facilitating authorizations/referrals as appropriate
• Coordinating internal and external resources to meet identified needs
• Monitoring and evaluating effectiveness of the care management plan and modifying as necessary
• Interfacing with Medical Directors and Physician Advisors on treatment plans
• Negotiating rates of reimbursement as applicable
• Assisting in problem solving with providers, claims or service issues

Requirements

• Requires BA/BS in a health-related field and minimum of 3 years of clinical experience
• Current, unrestricted RN license in applicable state(s) required
• Multi-state licensure is required if providing services in multiple states
• Certification as a Case Manager preferred
• BS in a health or human services related field preferred
• Previous OB/NICU experience preferred

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