Nurse Case Manager – 100% Virtual

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

📋 Description

• Provide care management within the boundaries of licensure for members with intricate and chronic care requirements.

• Evaluate, design, implement, coordinate, monitor, and assess care plans.

• Enhance member healthcare throughout the entire care continuum.

• Ensure members have access to services that align with their health needs.

• Carry out assessments to ascertain individual needs and objectives for care management.

• Facilitate authorizations and referrals within the benefits framework or through additional contractual arrangements.

• Coordinate both internal and external resources to satisfy identified needs.

• Monitor and assess the effectiveness of care plans, adjusting them as necessary.

• Collaborate with Medical Directors and Physician Advisors regarding care management treatment strategies.

• Negotiate reimbursement rates when applicable.

• Assist with provider, claims, or service-related issues.

• Execute responsibilities either telephonically or on-site, such as in hospitals for discharge planning.

⛳️ Requirements

• BA/BS in a health-related discipline and a minimum of 3 years of clinical experience; alternatively, a combination of education and experience that provides an equivalent background.

• A current, unrestricted RN license in the relevant state(s) is mandatory.

• Multi-state licensure is necessary if services are provided across multiple states.

• Certification as a Case Manager is preferred.

• Prior experience in case management is strongly preferred.

• Home health experience is strongly preferred.

• Availability from Monday to Friday, 11 am–8 pm CST.

• Candidates must live within a reasonable commuting distance from the job location(s), unless a legal accommodation is made.

• New hires in specific patient/member-facing positions must be vaccinated against COVID-19 and Influenza; an acceptable explanation is required if the individual is not vaccinated.

🏝️ Benefits

• Merit increases.

• Paid holidays.

• Paid Time Off.

• Incentive bonus programs (unless governed by a collective bargaining agreement).

• Medical benefits.

• Dental benefits.

• Vision benefits.

• Short-term disability benefits.

• Long-term disability benefits.

• 401(k) with matching contributions.

• Stock purchase plan.

• Life insurance.

• Wellness programs.

• Financial education resources.

• Virtual full-time work arrangement, except for mandatory in-person training sessions.

• Flexible work-life integration and autonomy.