Nurse Case Manager II

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

📋 Description

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

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

• Execute duties either via telephone or on-site, including hospital discharge planning.

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

• Conduct evaluations and develop care management plans that target identified objectives and goals.

• Facilitate authorizations and referrals within the benefit framework or through alternative contractual arrangements.

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

• Assess and review 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.

• Help resolve issues related to providers, claims, or services.

• Aid in the development of utilization and care management policies and procedures.

⛳️ Requirements

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

• An active, 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 discipline is preferred.

• Candidates must live within a reasonable commuting distance from the job location(s), unless a legally required accommodation is provided.

• Certain roles that involve interaction with patients/members require vaccination against COVID-19 and Influenza, unless an acceptable justification is given.

🏝️ Benefits

• Comprehensive benefits package.

• Incentive and recognition programs.

• Equity stock purchase options.

• 401k contributions.

• Merit-based salary increases.

• Paid holidays.

• Paid Time Off.

• Incentive bonus programs.

• Medical benefits.

• Dental benefits.

• Vision benefits.

• Short-term disability coverage.

• Long-term disability coverage.

• 401(k) with matching contributions.

• Stock purchase plan.

• Life insurance.

• Wellness programs.

• Financial education resources.

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