Nurse Case Manager II

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

📋 Description

• Manage care for members with complex and chronic health needs within the boundaries of licensure.

• Evaluate, develop, implement, coordinate, and monitor 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 create care management plans that address specific objectives and goals.

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

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

• 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.

• Support problem-solving related to providers, claims, or service issues.

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

⛳️ Requirements

• Candidates must be residents of Kentucky.

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

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

• Multi-state licensure is necessary if services are provided in several states.

• Certification as a Case Manager is preferred.

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

• Candidates should be within a reasonable commuting distance from the job location(s), unless a legal accommodation is provided.

• Certain roles that involve patient/member interaction require vaccination against COVID-19 and Influenza, unless a satisfactory explanation is given.

🏝️ Benefits

• Merit increases.

• Paid holidays.

• Paid Time Off.

• Incentive bonus programs.

• Medical benefits.

• Dental benefits.

• Vision benefits.

• Short and long-term disability benefits.

• 401(k) with matching.

• Stock purchase plan.

• Life insurance.

• Wellness programs.

• Financial education resources.

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