Nurse Case Manager II

This is a fully remote position, open to applicants in Colorado, +1 more state.

📋 Description

• Deliver care management for individuals with intricate and chronic health requirements within the boundaries of licensure.

• Evaluate members and create tailored care management strategies.

• Execute care plans through authorizations and referrals in accordance with benefit structures or additional contractual arrangements.

• Coordinate both internal and external resources effectively.

• Oversee 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.

• Aid in resolving provider, claims, and service-related issues.

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

• Guarantee member access to services that align with their health requirements.

• Execute responsibilities via phone or in-person, including hospital discharge planning.

⛳️ Requirements

• BA/BS in a health-related discipline and a minimum of 5 years of clinical experience; or an equivalent combination of education and experience.

• Current, unrestricted RN license in relevant state(s) is mandatory.

• Multi-state licensure is required when delivering services across multiple states.

• Certification as a Case Manager is highly preferred.

• A Bachelor's degree in a health or human services-related field is preferred.

• Work schedule is Monday-Friday, from 10:00 am to 6:30 pm EST.

• Candidates should reside within a reasonable commuting distance of the job location unless a special accommodation is provided.

• New candidates in specific patient/member-facing roles must be vaccinated against COVID-19 and Influenza unless a valid exemption is presented.

🏝️ Benefits

• Comprehensive benefits package.

• Merit-based salary 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) plan with matching contributions.

• Stock purchase plan.

• Life insurance.

• Wellness programs.

• Financial education resources.

• Flexibility for virtual work.

• Required in-person training sessions.

• Incentive and recognition programs.

• Equity stock purchase options.