RN Case Manager

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

📋 Description

• Conduct thorough assessments of beneficiaries and analyze results to recognize clinical, psychosocial, and behavioral issues as well as gaps in care.

• Create and document personalized case management care plans in collaboration with beneficiaries, families, physicians, and healthcare providers.

• Record concerns, objectives, interventions, resources, timelines, and obstacles within care plans.

• Coordinate and execute activities outlined in care plans to maximize benefits coverage and ensure continuity of care during transitions.

• Monitor, assess, modify, and update care plans to meet desired outcomes.

• Initiate care conferences with the Medical Director and multidisciplinary care teams for complex cases.

• Advocate for beneficiaries by fostering self-determination, informed decision-making, autonomy, and self-advocacy.

• Educate and assist beneficiaries in managing their own care and accessing services.

• Identify and coordinate benefit-related, educational, healthcare, and community resources.

• Implement comprehensive case management, patient-centered care coordination, culturally sensitive care, and management principles for complex conditions.

• Collaborate with beneficiaries, caregivers, providers, multidisciplinary teams, and community resources.

• Engage in training, professional development, team meetings, and conferences.

• Accurately and promptly maintain clinical documentation and data.

• Adhere to professional standards, organizational policies, privacy regulations, and HIPAA requirements.

⛳️ Requirements

• Current, unrestricted Registered Nurse license in the state of residence with the ability to obtain multi-state licensure.

• Citizenship status in the United States.

• Capability to obtain the required Security Clearance; current DOD Security Clearance is preferred.

• An Associate or bachelor's degree in nursing from an accredited institution; a bachelor's degree is preferred.

• Over 5 years of clinical RN experience in direct patient care.

• Familiarity with case management practices and patient-centered care principles.

• Proficiency in Microsoft Office, mobile technologies, and navigating various applications.

• Ability to adjust to shifting priorities.

• Prior experience in case management is preferred.

• Case Management Certification (CCM) is preferred.

• Experience in an NCQA and URAC accredited case management program is preferred.

• Previous telephonic case manager experience at a health plan is preferred.

• Ability to work independently in a home office setting.

• Must maintain CEUs as required by relevant State Boards of Nursing and necessary certifications.

• Must comply with federal and state regulations, including HIPAA.

🏝️ Benefits

• Supportive, dynamic, and innovative work environment.

• Opportunity to collaborate with experienced healthcare consultants.

• Exposure to a variety of client business areas.

• Mentoring program featuring senior-level professional advisors.

• Opportunities for professional growth and development.

• Continuous training and professional development.

• Participation in team meetings and conferences.

• Occasional travel for team meetings and limited client onsite engagements (up to 5% annually).