Nurse Case Manager I

Role Overview

• Perform care management telephonically within the scope of licensure for members with complex and chronic care needs
• Assess, develop, implement, coordinate, monitor, and evaluate care plans designed to optimize member health care
• Ensure member access to services appropriate to their health needs
• Conduct assessments to identify individual needs and a specific care management plan
• Implement care plan by facilitating authorizations/referrals as appropriate
• Coordinate internal and external resources to meet identified needs
• Monitor and evaluate effectiveness of the care management plan and modify as necessary
• Interface with Medical Directors and Physician Advisors on the development of care management treatment plans
• Assist 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, unrestricted RN license in applicable state(s)
• Multi-state licensure is required if providing services in multiple states
• Nurse case management experience is strongly preferred
• Experience working with Medicare and Medicaid programs is strongly preferred

Benefits

• 25 days annual leave
• Private healthcare
• Pension scheme
• Flexible working hours
• Professional development opportunities
• Merit increases
• Paid holidays
• Paid Time Off
• Incentive bonus programs
• Stock purchase plan
• Life insurance
• Wellness programs
• Financial education resources