RN Case Manager

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

📋 Description

• Develop, execute, and oversee treatment plans aimed at assisting patients/members in achieving their healthcare objectives.

• Evaluate members’ health conditions and their care coordination requirements.

• Conduct inpatient assessments, discharge planning, and potential outpatient management.

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

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

• Assess clinical conditions and their implications to facilitate appropriate service coordination.

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

• Identify services, resources, providers, and facilities that effectively cater to members in a timely and cost-efficient manner.

• Create and execute both short- and long-term case management objectives alongside documented care plans.

• Assess the cost-effectiveness of treatment plans prior to and following implementation.

• Generate precise and timely reports.

• Review medical records to ascertain medical necessity.

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

⛳️ Requirements

• Availability to work Monday to Friday, from 9 AM to 6 PM CST or 10 AM to 7 PM CST.

• Valid California RN state license.

• Over 5 years of relevant work experience with a professional background in clinical nursing and patient assessment.

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

• Graduate of an accredited nursing program.

• RN - Registered Nurse - State Licensure.

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

• Ability to collaborate across operational areas within the organization.

• Certified Case Manager (CCM) designation preferred.

• Compact State Licensure in good standing preferred.

• Previous experience in utilization management or case management, ideally within a managed care setting, preferred.

• Experience with intensive care or higher-acuity patients preferred.

• Familiarity with managed care in a self-funded employer population preferred.

• Capacity to identify issues such as underutilization or overutilization of services.

• Ability to promote and sustain quality care through analysis.

🏝️ Benefits

• 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 available.

• Comprehensive wellness program.