RN Case Manager

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

📋 Description

• Perform thorough assessments and analyze results to pinpoint and prioritize clinical, psychosocial, and behavioral issues as well as care gaps.

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

• Record issues, objectives, evidence-based interventions, resources, timelines, and obstacles in care plans.

• Coordinate and execute care plan activities, benefits coverage, continuity of care, and service integration throughout care transitions.

• Monitor and assess care plans, outcomes, and objectives; modify plans as necessary.

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

• Advocate for beneficiaries while fostering self-determination, shared decision-making, autonomy, self-advocacy, and self-care management.

• Identify and facilitate access to benefit-related, educational, healthcare, and community resources for care coordination.

• Employ comprehensive case management, patient-centered, culturally competent care coordination, and complex-condition management principles.

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

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

• Accurately and promptly document clinical information.

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

⛳️ Requirements

• Must possess a current, unrestricted Registered Nurse license in the state of residence.

• Capability to obtain multi-state licensure.

• United States citizenship is mandatory.

• Ability to secure required security clearance; current DOD Security Clearance is preferred.

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

• A minimum of 5 years of clinical RN experience in direct patient care is necessary.

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

• Proficient in Microsoft Office, mobile technologies, and navigating multiple applications.

• Ability to adapt 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.

• Telephonic case management experience at a health plan is preferred.

• Capability to work independently in a home office setting.

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

• Willingness to obtain and sustain additional licenses as necessary to meet business needs.

• Knowledge of applicable federal and state regulations, patient confidentiality, release of information, and HIPAA compliance.

🏝️ Benefits

• Supportive, dynamic, and innovative work environment.

• Opportunity to collaborate closely with experienced healthcare consultants.

• Exposure to various aspects of clients' businesses.

• Mentoring program with senior-level professional advisors.

• Opportunities for professional growth and development.

• Continuous training and professional development.

• Team meetings and collaboration opportunities.