Nurse Case Manager I

Role Overview

• responsible for 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
• performs duties telephonically or on-site such as at hospitals for discharge planning
• Ensures member access to services appropriate to their health needs
• Conducts assessments to identify individual needs and a specific care management plan to address objectives and goals as identified during assessment
• Implements care plan by facilitating authorizations/referrals as appropriate within benefits structure or through extra-contractual arrangements
• Coordinates internal and external resources to meet identified needs
• Monitors and evaluates effectiveness of the care management plan and modifies as necessary
• Interfaces with Medical Directors and Physician Advisors on the development of care management treatment plans
• Negotiates rates of reimbursement, as applicable
• Assists in problem solving with providers, claims or service issues

Requirements

• Requires BA/BS in a health related field
• minimum of 3 years of clinical experience
• Current and active RN license required in applicable state(s)
• Multi-state licensure is required if providing services in multiple states
• Certification as a Case Manager is preferred
• Previous MCO or Hospital Case Management experience is preferred
• Telephonic case management experience preferred

Benefits

• comprehensive benefits package
• incentive and recognition programs
• equity stock purchase
• 401k contribution
• merit increases
• paid holidays
• Paid Time Off
• short and long term disability benefits
• medical, dental, and vision benefits
• wellness programs
• financial education resources