RN Case Manager

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

📋 Description

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

• Utilize plan benefits and community resources to enhance cost-efficiency and promote cost containment.

• Practice nursing within the boundaries of licensure while adhering to policies, procedures, regulations, URAC standards, and state laws.

• Deliver specialized education on disease-specific conditions to patients.

• Keep abreast of the latest medical and surgical procedures, healthcare products and services, medications, and trends in healthcare delivery.

• 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.

• Articulate case-management services, secure voluntary consent, and manage a minimum patient caseload promptly.

• Execute other assigned responsibilities as needed.

⛳️ Requirements

• 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 performed is mandatory.

• Certification in case management is required; if not obtained prior to employment, a URAC-recognized certification must be acquired 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 necessary.

• Ability to practice nursing within the legal scope of licensure.

• Familiarity with URAC standards, state regulations, healthcare services, medical and surgical procedures, products, medications, healthcare delivery trends, policies, and contracts is essential.

• Proficiency in administrative processes, Affinite CM, Affinite UM, CCI Edits, Five9, Microsoft Excel, Microsoft Office, Microsoft Outlook, Microsoft PowerPoint, CRM, needs assessment, support coordination, critical reasoning, deductive reasoning, information security, as well as written and verbal communication skills.

• Must ensure the security and confidentiality of records and information.

• Compliance with segregation of duties guidelines is required.

🏝️ Benefits

• Option for remote work.

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

• Regular employment status.