RN Case Manager

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

📋 Description

• Evaluate, plan, implement, coordinate, monitor, and assess options and services to address individual health requirements utilizing plan benefits and community resources.

• Promote cost-effectiveness and implement cost containment strategies.

• Practice nursing within the boundaries of licensure while ensuring compliance, appropriate care levels, and patient safety.

• Deliver specialized education and insights on disease-specific conditions.

• Keep abreast of the latest medical and surgical procedures, products, healthcare services, pharmaceuticals, healthcare delivery trends, enterprise 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 identify suitable case management candidates, clarify services, secure voluntary consent, and maintain a minimum patient caseload.

• Execute additional responsibilities as assigned.

⛳️ Requirements

• A Bachelor's degree in Nursing is preferred.

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

• Case management certification is mandatory; if not acquired before employment, URAC-recognized certification must be obtained within three years of hire.

• 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.

• Ability to practice nursing within the scope of licensure and adhere to policies, regulations, URAC standards, and state laws.

• Competency in maintaining the security and confidentiality of records and information.

• Capability to follow segregation of duties guidelines.

• Strong independence and attention to detail.

• Proficient skills in Administrative Processes, Affinite CM, Affinite UM, CCI Edits, Collaborative Communications, Critical Reasoning, Cross-Functional Planning, Customer Relationship Management (CRM), Customer Service Workstation, Deductive Reasoning, Five9, Information Security, Interpersonal Relationship Management, Microsoft Excel, Microsoft Office, Microsoft Outlook, Microsoft PowerPoint, Needs Assessment, Oral Communications, Problem Sensitivity, Researching, Sound Judgment, Support Coordination, and Written Communication.

🏝️ Benefits

• Remote work arrangement.

• Regular employment status.

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

• Lifting and carrying allowance of up to 40 lbs as part of job requirements.