Case Manager, RN

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

📋 Description

• Facilitate telephonic case management by connecting providers, patients, and caregivers.

• Reach out to patients and conduct a comprehensive assessment that includes physical, psychosocial, emotional, spiritual, environmental, and financial aspects.

• Utilize claims processing tools to analyze and investigate paid claim data to create a clinical overview of a member’s health status.

• Collaborate with patients, caregivers or family, community resources, and multi-disciplinary healthcare providers to formulate treatment plans for both standard and catastrophic cases.

• Oversee interventions and assess the effectiveness of the treatment plan promptly.

• Advocate for patients by promoting the delivery of quality care and aiding in minimizing overall costs.

• Ensure thorough and detailed documentation for all case-managed patients.

• Assess and recommend referrals for wellness programs.

⛳️ Requirements

• Familiarity with medical claims and knowledge of ICD-10, CPT, and HCPCS coding.

• Capacity to critically assess claims data and formulate treatment plans, along with discharge planning experience.

• Ability to work autonomously, making decisions and solving problems effectively.

• Awareness of community resources and alternative funding programs.

• Proficiency in computer skills or a working knowledge of Microsoft Office Suite.

• Outstanding interpersonal, communication, and negotiation abilities.

• Strong orientation towards customer service.

• Excellent time management skills and a high level of organization.

🏝️ Benefits

• Competitive base salary and benefits starting from day one.

• Comprehensive medical and dental coverage through our proprietary health solutions (yes, we utilize what we create).

• Paid Time Off—time to rest and recharge is essential and non-negotiable.

• Mental health support, retirement planning, and financial protection services.

• Opportunities for professional development with clear career progression and learning budgets.

• A mission-driven culture where diverse viewpoints contribute to significant improvements in people's health.