RN Case Manager

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

📋 Description

• Evaluate the health status and care coordination needs of members.

• Facilitate inpatient reviews and discharge planning, along with potential outpatient management.

• Communicate with patients, families, physicians, healthcare providers, community resources, provider business offices, and employers/clients.

• Identify and coordinate alternative treatment strategies within quality-care and cost-containment frameworks.

• Assess clinical status and consequences while coordinating suitable healthcare services.

• Monitor health status and the effectiveness of treatment plans, modifying care strategies as member requirements evolve.

• Identify timely and cost-effective services, resources, providers, and facilities.

• Develop and implement short- and long-term Case Management objectives with documented care plans.

• Evaluate the cost-effectiveness of treatment plans before and after execution.

• Deliver accurate and timely reports.

• Review medical records to assess medical necessity.

• Interpret individual health plans and authorize or coordinate care in accordance with plan provisions.

⛳️ Requirements

• A minimum of 5 years of relevant experience with a professional focus in clinical nursing and patient assessment.

• A related Bachelor's degree or equivalent relevant work experience.

• Graduate of an accredited nursing school.

• RN - Registered Nurse - State Licensure.

• Compact State Licensure in good standing.

• Familiarity with medical terminology, appropriate and necessary treatment plans, and practices for delivering quality healthcare and cost containment.

• Ability to collaborate across various operational areas within the organization.

• Working hours: Monday to Friday, 8 am - 5 pm Central Time.

🏝️ Benefits

• Medical, dental, vision, life, and global travel health insurance.

• Short- and long-term disability programs.

• Leave programs to accommodate personal circumstances.

• Retirement Savings Plan with employer contributions and matching.

• Paid time off.

• Volunteer time off.

• 11 holidays.

• Additional voluntary benefits.

• Comprehensive wellness program.