RN Case Manager

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

📋 Description

• Evaluate, design, implement, coordinate, monitor, and assess comprehensive care plans, options, and services tailored to individual health requirements.

• Leverage plan benefits and community resources to enhance cost-effectiveness and ensure cost containment.

• Provide nursing care in accordance with licensure standards and make evidence-based decisions to guarantee compliance, suitable levels of care, and patient safety.

• Offer specialized education and insights on disease-specific conditions as necessary.

• Stay updated on medical and surgical procedures, healthcare products, services, pharmaceutical advancements, healthcare delivery trends, organizational procedures, policies, and contracts.

• Act as a liaison among patients, families/caregivers, physicians, hospital discharge planners, home care providers, and ancillary service providers.

• Collaborate proactively with referrals to pinpoint suitable case-management candidates, clarify services, secure voluntary consent, and maintain an efficient minimum patient caseload.

• Execute additional responsibilities as assigned.

⛳️ Requirements

• A Bachelor's degree in Nursing is preferred.

• A current active Registered Nurse (RN) state license in good standing in the state(s) where job responsibilities are executed is required.

• A case management certification is necessary; if not acquired before employment, a URAC-recognized certification must be obtained within three years of being hired as an RN Case Manager.

• Acceptable certifications include Certified Case Manager (CCM), Accredited Case Manager (ACM), or Registered Nurse - Board Certified (RN-BC).

• A minimum of four years of clinical practice experience in case management, home health, critical care, medical/surgical, discharge planning, concurrent review, or obstetric/neonatal care is required.

• Proficiency in Administrative Process, Affinite CM, Affinite UM, CCI Edits, Five9, Information Security, Microsoft Excel, Microsoft Office, Microsoft Outlook, and Microsoft PowerPoint.

• Strong skills in collaborative communication, critical reasoning, cross-functional planning, customer relationship management, customer service workstation, deductive reasoning, interpersonal relationship management, needs assessment, oral communication, problem sensitivity, research, sound judgment, support coordination, and written communication.

• Must comply with all relevant policies, procedures, regulations, URAC standards, and state regulations.

• Required to maintain the security and confidentiality of records and information.

• Must adhere to segregation of duties guidelines.

🏝️ Benefits

• Remote work arrangement.

• Campus travel within walking distance of the primary work location.

• Regular employment.