Case Manager, Registered Nurse

Role Overview

• Develops a proactive course of action to address issues presented to enhance the short and long-term outcomes as well as opportunities to enhance a member’s overall wellness through integration.
• Conducts an evaluation of member’s needs and benefit plan eligibility and facilitates integrative functions.
• Applies clinical judgment to incorporate strategies designed to reduce risk factors and barriers and address complex health and social indicators that impact care planning and resolution of member issues.
• Reviews prior claims to address potential impact on current case management and eligibility.
• Utilizes case management processes in compliance with regulatory and company policies and procedures.
• Utilizes interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversation.

Requirements

• Must have an active and unrestricted RN license in the state of North Carolina.
• Multiple State RN licensure is welcomed but not required.
• 2+ years of clinical experience as an RN
• All clinical experience will be considered, such as Emergency Department, Home Health, Hospice, Operating Room, ICU, NICU, Telemetry, Medical / Surgical, Orthopedics, Long Term Care, and Infusion nursing.

Benefits

• medical, dental, and vision coverage
• paid time off
• retirement savings options
• wellness programs
• comprehensive benefits package