Case Manager, RN

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

📋 Description

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

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

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

• Execute and coordinate care plans while 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 address members’ individual healthcare needs.

• Communicate and collaborate with physicians, providers, colleagues, and healthcare team members.

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

• Identify opportunities for cost savings, quality enhancements, and workflow improvements.

• Detect, resolve, and prevent inappropriate utilization of member benefits.

• Carry out additional duties as assigned or requested.

⛳️ Requirements

• High School Diploma or GED is required.

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

• Current RN licensure in the State of Pennsylvania OR current multi-state licensure through the enhanced Nurse Licensure Compact (eNLC) or in West Virginia, Delaware, or New York is required.

• Any additional RN licenses must be obtained within the first 6 months of employment.

• Strong skills in assessment and care planning.

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

• Proficiency in Microsoft applications, case management software, and electronic health records.

• Knowledge of healthcare systems and principles of case management.

• A Bachelor's Degree in Nursing is preferred.

• Experience in addressing the healthcare needs of diverse populations is preferred.

• Experience demonstrating cultural competency in working with targeted populations is preferred.

🏝️ Benefits

• Options for remote work.

• Travel requirements ranging from 0% to 25%.