Case Manager, RN – Bilingual

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

📋 Description

• Oversee a personal caseload utilizing the Case Management process.

• Approve services and assess treatment plans for medical necessity and care standards.

• Maintain continuous communication with providers, payers, patients, caregivers, social workers, insurance teams, and other healthcare professionals.

• Create, revise, and uphold accountability for Case Management plans.

• Evaluate patient issues, establish goals and interventions, and document case notes.

• Confirm benefit limitations with payer organizations.

• Validate medical necessity of prescribed care and equipment with providers and vendors.

• Coordinate quality patient care based on patient needs, physician directives, and available benefits.

• Oversee Case Management files and retain responsibility for the Case Management documentation.

• Identify alternative treatment options and prepare cost-benefit analyses for potential extra-contractual services.

• Connect patients with community resources and financial support.

• Record all case activities and finalize case records in the computer system.

• Generate timely reports for payers outlining case actions, outcomes, and ongoing plans.

• Manage billing within the computer system as necessary.

• Maintain contact throughout the continuum of care and periodically monitor chronic-condition cases.

• Negotiate with providers to optimize medical benefits and facilitate network referrals.

• Address non-medical concerns related to patient safety or welfare.

• Regularly consult with the Director of Case Management and notify the supervisor of any complaints or issues that need escalation.

• Engage in the Quality Management Program and identify opportunities for enhancing service quality.

• Contribute to the annual performance evaluation of the designated Case Management Assistant.

⛳️ Requirements

• Registered Nurse (R.N.)

• Current, active, and unrestricted RN license in the state of practice and residence within the United States or its territories.

• Bachelor's degree in a health-related field is preferred.

• At least 7 years of diverse clinical experience is preferred.

• Strong organizational and time-management abilities.

• Exceptional verbal and written communication skills.

• Capability to handle challenging situations with tact and diplomacy.

• Proficient problem-solving and decision-making skills.

• Strong computer proficiency.

• Expertise in Microsoft Office Suite, including Word, Excel, and PowerPoint.

• Fluent in English and Spanish, with strong reading and writing skills in both languages.

• Ability to independently manage moderately complex cases and contribute to team objectives.

• Must secure a URAC-recognized certification in Case Management within three years of hire.

• Eligibility to work in the United States without employer sponsorship.

🏝️ Benefits

• Paid time off

• Medical insurance

• Dental insurance

• Vision insurance

• Short-term disability

• Long-term disability

• Life insurance

• AD&D insurance

• 401(k) with matching contributions

• Critical illness coverage

• Legal plan

• Identity theft coverage

• Pet insurance

• Discount programs

• Eligibility for bonus programs

• Pay differential for bilingual Spanish-speaking employees