Case Manager

This is a fully remote position, open to applicants in North Carolina, +2 more states.

📋 Description

• Facilitate care, resources, and services for designated member populations.

• Offer guidance and promote the effective use and monitoring of healthcare resources.

• Collaborate with members of the healthcare team to attain optimal clinical and resource outcomes.

• Conduct comprehensive assessments and coordinate treatment, interventions, and discharge planning.

• Create member-centric plans customized to individual needs, health status, education, and support requirements.

• Identify obstacles to achieving goals or care plans and leverage community resources and funding sources.

• Monitor and manage members through follow-ups, education, referrals, documentation, and plan adjustments.

• Assess and facilitate care across physician offices, hospitals, rehabilitation units, skilled nursing facilities, and home care settings.

• Educate members and promote proactive interventions to reduce expenses and enhance outcomes.

• Document assessments, planning, implementation, monitoring, and outcomes effectively.

• Conduct outreach to high-risk, high-cost, or high-utilization members as necessary.

• Review alternative treatment plans, benefits, exceptions, and flexible benefit options.

• Assess the medical necessity and appropriateness of services provided.

• Develop policies, procedures, education, or training as necessary.

⛳️ Requirements

• RN with a minimum of 3 years of clinical and/or case management experience required.

• Must possess and maintain a valid and applicable clinical license (NC or compact multi-state licensure).

• Additional specialty certification (e.g., CCM, CDCES) may be mandated for certain roles; if required, it must be obtained within 2 years of employment.

• One or more additional nursing licenses from non-compact states are strongly preferred.

• Extensive clinical nursing experience across various care settings is highly desirable, including Medical-Surgical, ICU, Emergency Department, Pediatrics, Labor & Delivery, and other inpatient specialties.

🏝️ Benefits

• Medical, dental, and vision coverage.

• Health and wellness programs.

• Parental leave and support.

• Adoption and surrogacy assistance.

• Career development programs.

• Tuition reimbursement for ongoing education.

• 401k match along with an annual company contribution.

• Annual Incentive Bonus.

• Paid Time Off (PTO).

• Emphasis on work-life balance, flexibility, and autonomy.

• Opportunities for remote work with occasional in-office visits each year for meaningful engagements.