Case Management Nurse I

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

📋 Description

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

• Develop and oversee personalized care plans.

• Collaborate with members, families, healthcare providers, and community resources to coordinate services and care.

• Utilize critical thinking to identify high-risk and complex conditions while anticipating member needs.

• Address care requirements through supportive interventions and planning strategies.

• Recognize barriers and gaps in care, facilitating appropriate services and referrals.

• Educate members regarding their responsibilities, expected outcomes, benefits, and available services.

• Investigate emerging resources and programs, collaborating with Wellmark stakeholders.

• Accurately document care management activities using relevant technology, ensuring consistency and timeliness.

• Adhere to regulatory, accreditation, and internal standards.

• Be available to work weekend and/or holiday hours on a rotational basis as necessary.

• Perform additional duties as assigned.

⛳️ Requirements

• Completion of an accredited nursing program is required.

• Must possess an active and unrestricted RN license in Iowa or South Dakota; licensing in the state of residence is mandatory.

• Certified Case Manager (CCM) certification is to be obtained within 24 months of hire and maintained throughout employment.

• A minimum of 4 years of diverse clinical experience, including at least 4 years of direct clinical care to consumers.

• Experience in care navigation/care coordination is strongly preferred.

• Behavioral health experience is preferred.

• Prior experience in a health plan is preferred.

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

• Strong verbal and written communication skills are essential.

• Ability to accurately document in case management platforms.

• Demonstrated critical thinking, problem-solving abilities, and independent decision-making skills, with a capacity to manage ambiguity.

• Capability to organize and manage multiple priorities within a fast-paced environment.

• Strong technical skills, including proficiency in Microsoft Office, clinical documentation platforms, and the ability to learn new systems.

• Knowledge of URAC, NCQA, HIPAA, and PHI confidentiality standards and regulations is important.

• Flexibility to work weekend and/or holiday hours on a rotational basis when required.

• High-speed internet access is necessary at the remote work location.

• Applicants must not require immigration sponsorship or additional/permanent work authorization in the United States.

🏝️ Benefits

• Eligibility for fully remote work.

• Flexibility to work in a location that maximizes productivity.

• Option to visit a Wellmark office based on location.

• Support for the responsible use of AI in the workforce and for job seekers.

• Reasonable accommodation support available during the application process.