Case Management Nurse I

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

📋 Description

• Connect with members through various channels to assist with chronic and/or complex healthcare needs.

• Develop and oversee customized care plans.

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

• Utilize critical thinking to recognize high-risk and complex situations while anticipating member needs.

• Address care requirements through supportive interventions and effective planning methods.

• Identify obstacles and gaps in care, ensuring proper communication, education, and the prevention of duplicated services.

• Involve members in care management plans and inform them about their responsibilities, outcomes, benefits, and services.

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

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

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

• Adhere to regulatory, accreditation, and internal standards.

• Be available to work weekends and/or holidays on a rotational basis as necessary.

• Perform additional duties as assigned.

⛳️ Requirements

• Completion of a nursing program accredited by the appropriate authorities.

• Possession of an active and unrestricted RN License in Iowa or South Dakota.

• Must hold a license in the state of residence.

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

• Minimum of 4 years of varied clinical experience, including at least 4 years of direct clinical care to patients.

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

• Behavioral health experience is preferred.

• Prior experience in a health plan setting is preferred.

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

• Excellent verbal and written communication skills.

• Proficient documentation skills in case management platforms.

• Strong critical thinking and problem-solving abilities.

• Familiarity with resources, processes, and guidelines.

• Capability to make independent decisions or recommendations amidst uncertainty.

• Ability to organize and manage multiple priorities effectively.

• Commitment to timeliness, follow-up, accuracy, and attention to detail.

• Flexibility and adaptability to changing circumstances.

• Strong technical skills and the ability to quickly learn new systems.

• Proficiency in Microsoft Office applications, including Outlook, Excel, and Teams.

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

• Willingness to work weekends and/or holidays on a rotational basis when necessary.

• Ability to provide high-speed internet at the work location.

• Must not require immigration sponsorship or additional/permanent work authorization 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 provided by the candidate at their work location.

• Responsible use of AI is supported and encouraged.

• Commitment to equal opportunity employment.

• Provision of reasonable accommodations during the employment application process.