Nurse Case Manager I

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

📋 Description

• Deliver telephonic care management for members facing complex and chronic health challenges within the boundaries of licensure.

• Evaluate members and create tailored care management plans.

• Execute care plans by securing authorizations and referrals within the benefits framework or via extra-contractual arrangements.

• Organize both internal and external resources to address identified needs.

• Review and assess the effectiveness of care plans, making adjustments as needed.

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

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

• Aid in problem-solving related to providers, claims, or services.

• Contribute to the development of utilization and care management policies and procedures.

• Provide services to members across various states.

⛳️ Requirements

• A BA/BS in a health-related discipline is required.

• A minimum of 3 years of clinical experience, or an equivalent combination of education and experience.

• A current, unrestricted RN license issued by the State of Georgia is mandatory.

• Multistate licensure is necessary when delivering services in multiple states.

• Capability to converse and type simultaneously.

• Certification as a Case Manager is required.

• Ability to demonstrate critical thinking skills during interactions with members.

• Proficiency in Microsoft Office and/or a quick aptitude for learning new computer systems/software.

• Capacity to manage, review, and respond to emails and instant messages promptly.

• Residency in the State of Georgia is essential.

• Completion of the online pre-employment skills assessment within 48 hours of receipt, meeting the specified criteria is required.

• Availability from Monday to Friday, 11:00 am to 7:30 pm, with one shift each week from 8:30 am to 5:00 pm EST.

🏝️ Benefits

• Merit-based salary increases.

• Paid holidays.

• Paid Time Off (PTO).

• Incentive bonus programs.

• Medical insurance benefits.

• Dental insurance benefits.

• Vision insurance benefits.

• Short-term disability coverage.

• Long-term disability coverage.

• 401(k) plan with matching contributions.

• Stock purchase plan.

• Life insurance coverage.

• Wellness initiatives.

• Financial education resources.

• Full-time virtual work with flexibility and autonomy.

• Mandatory in-person training sessions.

• Accommodation for eligible candidates as required by law.