RN Case Manager

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

📋 Description

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

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

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

• Provide specialized education regarding disease-specific conditions.

• Stay updated on medical and surgical procedures, healthcare products and services, pharmaceuticals, 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 identify suitable candidates for case management.

• Clarify case management services, secure voluntary consent, and effectively manage a minimum patient caseload in a timely manner.

• Carry out additional responsibilities as assigned.

⛳️ Requirements

• Bachelor's degree in Nursing is preferred.

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

• Certification in case management is required; if not obtained prior to employment, the candidate must acquire a URAC-recognized certification within three years of being hired as an RN Case Manager.

• Acceptable certifications for case management 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 Processes, Affinite CM, Affinite UM, CCI Edits, Five9, Microsoft Excel, Microsoft Office, Microsoft Outlook, and Microsoft PowerPoint.

• Familiarity with information security, needs assessment, support coordination, CRM, and research methodologies.

• Ability to work independently with a strong attention to detail.

• Must adhere to nursing practice guidelines within the scope of licensure and comply with URAC standards and relevant state regulations.

🏝️ Benefits

• Remote work arrangement.

• Regular employment.