Case Management Nurse I

This is a fully remote position, open to applicants in Iowa.

📋 Description

• Engage with members across various channels to assist with chronic and/or complex health care requirements.

• Develop and oversee customized care plans.

• Collaborate with members, families, health care professionals, and community resources to ensure coordinated care and services.

• Identify high-risk and complex health conditions while anticipating the needs of members.

• Address care requirements using supportive interventions and planning strategies.

• Recognize barriers and gaps in care to avoid service duplication.

• Inform members about benefits, services, responsibilities, and expected outcomes.

• Investigate resources and programs as advancements in science and technology occur.

• Work together with both internal and external clinical and nonclinical partners.

• Facilitate referrals to providers, community resources, and Wellmark programs.

• Accurately document care management activities in a timely manner using appropriate technology tools.

• Adhere to regulatory, accreditation, and internal standards.

• Be available for weekend and/or holiday shifts on a rotational basis when necessary.

• Carry out additional duties as assigned.

⛳️ Requirements

• Completion of a recognized nursing program.

• Active and unrestricted RN License in Iowa or South Dakota.

• Must hold a license in the state of residence.

• Certified Case Manager (CCM); must be obtained within 24 months of hire and maintained throughout employment.

• A minimum of 4 years of varied clinical experience, including 4 years of direct clinical care to consumers.

• Experience in care navigation or care coordination is highly preferred.

• Behavioral health experience is preferred.

• Prior experience in a health plan setting is preferred.

• Experience in utilization management or within a health insurance environment is advantageous.

• Excellent verbal communication and written documentation skills.

• Strong critical thinking and problem-solving abilities.

• Capability to make independent decisions or recommendations in ambiguous situations.

• Ability to prioritize and manage multiple tasks in a fast-paced environment.

• Proficient technical skills, including knowledge of Microsoft Office and clinical documentation platforms.

• Understanding of URAC, NCQA, HIPAA, and PHI confidentiality standards.

• Willingness to work rotational weekend and/or holiday hours as needed.

• Must provide high-speed internet at the designated work location.

• Must not require immigration sponsorship or additional/permanent work authorization sponsorship now or in the future to work in the United States.

🏝️ Benefits

• Eligibility for fully remote work.

• Option to work from a Wellmark office based on location.

• High-speed internet to be supplied by the candidate at their work location.

• Opportunity to utilize responsible AI tools in the workplace and application process.