RN Case Manager

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

📋 Description

• Oversee case assignments through comprehensive patient outreach via telephone, thorough documentation, monitoring, progression, and closure of cases.

• Extract, organize, and analyze data to evaluate member eligibility for the Population Health management initiative.

• Coordinate and deliver timely, effective, equitable, safe, and member-focused care in accordance with HMO protocols.

• Adhere to reporting and documentation requirements.

• Participate in collaborative meetings with department personnel and clients.

• Assist members in achieving wellness and health independence by addressing barriers, social determinants, motivators, and psychosocial challenges.

• Educate members on navigating the HMO and the broader healthcare system.

• Advocate for quality and cost-efficient interventions and outcomes.

• Support the operational elements of the division to fulfill customer requirements and enhance satisfaction.

• Ensure confidentiality of computer systems, medical records, and data.

• Engage in QM/UM Committee Meetings, which includes preparing materials, taking minutes, collecting and analyzing data, and carrying out reporting and follow-up tasks.

• Participate in off-hours/weekend call rotation when necessary.

• Commit to ongoing professional development and education that reflects contemporary nursing care practices.

• Fulfill additional responsibilities as assigned in alignment with annual program objectives.

⛳️ Requirements

• Valid IL Registered Nurse License.

• Compliance with the Illinois Practice Act and possession of an Illinois nursing license.

• At least five years of experience across various healthcare settings.

• Extensive expertise in Case Management and Chronic Condition Management.

• Previous experience working remotely and/or through telephonic communication.

• Familiarity with utilization review, quality improvement, managed care, and/or community health.

• Basic understanding of case management principles, healthcare management, and reimbursement factors.

• Proficient in motivational interviewing techniques.

• Exceptional clinical judgment.

• Highly proficient in both verbal and written communication.

• Strong organizational, problem-solving, and time-management abilities.

• Capability to ensure the timely completion of projects and assignments.

• Ability to prioritize and respond to rapidly evolving business demands.

• Competent in working independently and remotely with multitasking capabilities for dynamic workflows.

• Proficiency in software tools, including word processing and spreadsheets.

• Computer skills encompassing MS Word, Excel, Access, PDF, and Outlook.

• Experience with navigating multiple Electronic Medical Records (EMRs).

• Must have an internet connection with a minimum of 100 Mbps download and 10 Mbps upload speed.

• Certification in Case Management is preferred, though not mandatory.

🏝️ Benefits

• Work from home / fully remote work arrangement.

• Comprehensive Medical, Dental, and Vision plans.

• 401(k) plan with a 3% employer match based on your 6% contribution.

• Life and Disability insurance options.

• Voluntary Life options available.

• Employee Assistance Program (EAP).

• Paid time off plans.

• Paid parental leave.

• Resources for learning and development.

• Necessary work equipment provided at no cost.

• Flexible remote work arrangements.

• Opportunities for virtual meetings and collaboration.