Nurse Case Manager II

This is a fully remote position, open to applicants in Illinois, +5 more states.

📋 Description

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

• Evaluate, design, implement, coordinate, monitor, and assess care plans across the entire care spectrum.

• Conduct duties via telephone.

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

• Carry out assessments to identify individual needs alongside care management objectives and goals.

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

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

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

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

• Negotiate reimbursement rates where applicable.

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

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

⛳️ Requirements

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

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

• Multi-State Licensure is essential due to the role servicing members in various states.

• Experience in Case Management.

• Background in Utilization Management.

• Certification as a Case Manager is required.

• At least 2 years of experience in an acute care environment.

• Familiarity with Microsoft Office and/or the ability to quickly learn new computer programs, systems, or software.

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

• Candidates must live within commuting distance of an office, unless accommodations are provided as mandated by law.

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

🏝️ Benefits

• Merit-based salary increases.

• Paid holidays.

• Paid Time Off.

• Incentive bonus programs.

• Medical insurance.

• Dental coverage.

• Vision coverage.

• Short-term disability benefits.

• Long-term disability benefits.

• 401(k) with matching contributions.

• Stock purchase plan.

• Life insurance.

• Wellness initiatives.

• Financial education resources.

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

• Flexible work-life integration.

• Support for COVID-19 and Influenza vaccinations for certain patient/member-facing positions.