Case Manager, RN

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

📋 Description

• Perform telephonic case management for complex, high-risk members, which includes identifying needs, assessing conditions, planning and coordinating care, and monitoring outcomes.

• Collaborate with healthcare providers to promote holistic, healthy, and beneficial outcomes.

• Stay informed about patient needs and changes in their conditions through communication with various departments, networks, and outreach to members.

• Advocate for patients, provide support, assess quality of care, and intervene during crises.

• Coordinate member services and community resources alongside other team members involved in care.

• Educate members and their caregivers on medical conditions and self-management strategies.

• Initiate and engage in SNP MOC activities, including completing HRAs, creating ICPs, and starting ICTs.

• Carry out transition-of-care responsibilities, such as post-discharge assessments, medication reconciliation/reviews, and ensuring access to follow-up care.

⛳️ Requirements

• High School diploma or equivalent educational qualification.

• A valid Registered Nurse license in the state of Oklahoma is mandatory.

• Possession of an active multi-state RN license is preferred.

• Prior experience in managed care or utilization management is advantageous.

• Familiarity with current nursing processes, techniques, and accepted standards is essential.

• Understanding of disease management, medications, and community resources is required.

• Excellent attention to detail along with strong organizational, multitasking, and time-management abilities.

• Proficient in clear and effective oral and written communication.

• Knowledge of Microsoft Word, Excel, and PowerPoint is necessary.

• Capability to work independently as well as collaboratively within a team.

• Reliable and secure internet connection is required.

• Ability to uphold the confidentiality of business information and Protected Health Information in line with HIPAA and company policy.

• Must adhere to company privacy and security protocols.

🏝️ Benefits

• Flexible remote work environment.

• No travel obligations required.