Nurse Case Manager II

This is a fully remote position, open to applicants in Colorado, +2 more states.

📋 Description

• Provide care management within the limits of licensure for members with complex and chronic healthcare needs.

• Evaluate, develop, implement, coordinate, monitor, and assess care plans throughout the care continuum.

• Carry out responsibilities via telephone or in-person, including at hospitals for discharge planning.

• Ensure that members have access to services that are suitable for their health requirements.

• Conduct assessments and formulate care management plans that address identified objectives and goals.

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

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

• Monitor and assess the effectiveness of care plans and adjust them as needed.

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

• Negotiate reimbursement rates when applicable.

• Assist in resolving provider, claims, or service-related issues.

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

⛳️ Requirements

• A BA/BS in a health-related field with a minimum of 5 years of clinical experience, or a combination of education and experience that provides an equivalent background.

• A current and 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.

• A BS in a health or human services-related field is preferred.

• Candidates must live within a reasonable commuting distance from the posting location(s), unless an accommodation is granted as required by law.

• Candidates in certain patient/member-facing roles must be vaccinated against COVID-19 and Influenza unless an acceptable exemption is provided.

🏝️ Benefits

• Comprehensive benefits package.

• Incentive and recognition programs.

• Equity stock purchase options.

• 401k contribution.

• Merit increases.

• Paid holidays.

• Paid Time Off.

• Incentive bonus programs.

• 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 with required in-person training sessions.

• Vaccination against COVID-19 and Influenza for specific patient/member-facing roles.