Case Manager Registered Nurse – Field

Role Overview

• Conduct comprehensive telephonic and in-person assessments to evaluate members' medical and behavioral health needs
• Develop and implement individualized care plans, ensuring alignment with clinical and program guidelines
• Coordinate and monitor ongoing care plan activities, adjusting as needed to improve outcomes
• Collaborate in multidisciplinary care reviews to optimize member health results
• Identify and escalate quality of care concerns through appropriate channels
• Engage members using motivational interviewing and coaching techniques to encourage healthy lifestyle choices
• Educate and empower members to actively participate in healthcare decision-making with their providers
• Use strong negotiation and coordination skills to secure appropriate services and resources
• Ensure accurate and timely documentation, adhering to regulatory, accreditation, and company standards
• Serve as a preceptor and mentor to new nurses and clinical staff
• Support onboarding by teaching policies, workflows, and best practices
• Foster a positive, supportive learning environment that promotes clinical excellence

Requirements

• Active, unrestricted Registered Nurse (RN) license
• Bachelor’s degree in Nursing (BSN)
• Minimum 3+ years of clinical experience
• At least 1+ years of case management experience
• Experience in a Managed Care Organization (MCO) preferred
• STAR Kids program experience preferred
• Bilingual (English/Spanish) preferred

Benefits

• health insurance
• dental and vision coverage
• paid time off
• retirement savings options
• wellness programs