Case Manager, RN

This is a fully remote position, open to applicants in Alabama, +46 more locations.

📋 Description

• Deliver comprehensive case management services to members.

• Oversee a caseload of members with moderate complexity health requirements.

• Evaluate members’ health status, needs, and available resources.

• Create personalized care plans in collaboration with members, physicians, and other healthcare providers.

• Implement and coordinate care plans, ensuring access to suitable services and resources.

• Facilitate referrals to specialists and community resources.

• Track member progress and modify care plans as necessary.

• Assess the effectiveness of interventions and services.

• Serve as an advocate and liaison to fulfill members’ individual healthcare needs.

• Collaborate and communicate effectively with physicians, providers, coworkers, and healthcare team members.

• Record activities in alignment with business processes, company policies, regulatory requirements, and accreditation standards.

• Identify potential cost savings, quality enhancements, and workflow efficiencies.

• Identify, address, and prevent improper utilization of member benefits.

• Carry out other tasks as assigned or requested.

⛳️ Requirements

• High School Diploma/GED.

• 3 years of experience in any combination of clinical, case/utilization management, and/or disease condition management, or provider operations and/or health insurance.

• Current State of PA RN licensure OR current multi-state licensure through the enhanced Nurse Licensure Compact (eNLC) or in WV, DE, or NY.

• Any other RN license(s), if applicable, must be obtained within the first 6 months of employment.

• Proficiency in utilizing the Microsoft suite of applications, case management software, and electronic health records.

• Strong skills in assessment and care planning.

• Understanding of healthcare systems and case management principles.

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

• Preferred: Bachelor's Degree in Nursing.

• Preferred: Experience addressing the healthcare needs of diverse populations.

• Preferred: Experience that demonstrates an understanding of the significance of cultural competency in meeting the needs of targeted populations.

• Language requirement other than English: None.

• Travel requirement: 0% - 25%.

🏝️ Benefits

• Competitive salary and comprehensive benefits package.

• Opportunities for professional development and career advancement.

• Supportive work environment with a focus on team collaboration.