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 healthcare providers.

• Execute and coordinate care plans while ensuring access to necessary services and resources.

• Manage referrals to specialists and community resources.

• Track member progress and modify care plans as required.

• Assess the effectiveness of interventions and services provided.

• Serve as an advocate and liaison for members’ specific healthcare needs.

• Foster communication and collaboration with physicians, providers, colleagues, and healthcare team members.

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

• Identify opportunities for cost savings, quality enhancements, and operational efficiencies.

• Recognize, address, and prevent improper use of member benefits.

• Carry out additional duties as assigned or requested.

⛳️ Requirements

• High School Diploma or GED.

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

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

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

• Experience addressing the healthcare needs of diverse populations.

• Proven understanding of the significance of cultural competency in serving targeted populations.

• Strong skills in assessment and care planning.

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

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

• Knowledge of healthcare systems and case management principles.

• Adherence to HIPAA, data security regulations, company policies, legal requirements, and accreditation standards.

🏝️ Benefits

• Opportunity for remote work.

• Travel requirements ranging from 0% to 25%.