RN Case Manager

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

📋 Description

• The primary duty of the RN Case Manager is to develop, implement, and oversee treatment plans that help patients/members achieve their healthcare objectives.

• The Case Management process involves evaluating the member’s health condition and care coordination requirements. This may include inpatient reviews, discharge planning, and potential outpatient management.

• Interaction with patients, families, physicians, other healthcare providers, and community resources is essential. Engagement with provider business offices and the employer/client may also be necessary.

• Identification of alternative treatment options, which must be approved by all involved parties.

• Evaluation of the clinical status and subsequent sequela to coordinate the most suitable services for the individual’s healthcare needs.

• Identification of services, resources, providers, and facilities that can effectively serve members in a prompt and cost-efficient manner.

• Establishment and execution of Case Management objectives, both short-term and long-term, with documented care plans.

• Leverage technology and resources to assess the cost-effectiveness of the selected treatment plan, both before and after implementation.

• Ensure accurate and timely reporting as required by each client member.

• Review medical records to ascertain the medical necessity of requested services.

• Interpret individual health plans and authorize/coordinated care according to plan stipulations.

⛳️ Requirements

• A minimum of 5 years of relevant work experience with a professional background in clinical nursing and patient evaluation.

• A related Bachelor’s degree or equivalent work experience in a related field.

• Graduation from an accredited nursing school.

• RN - Registered Nurse - State Licensure required.

• Compact State Licensure in good standing.

• Proficient in medical terminology, reasonable and necessary treatment plans, delivery of quality healthcare services, and cost containment practices.

• Ability to collaborate effectively with cross-functional areas within the organization.

🏝️ Benefits

• Comprehensive medical, dental, vision, life, and global travel health insurance.

• Income protection benefits including life insurance and short- and long-term disability programs.

• Leave programs designed to support personal circumstances.

• Retirement Savings Plan featuring employer contributions and matching.

• Paid time off, volunteer time off, and 11 holidays.

• Additional voluntary benefits and a comprehensive wellness program available.