RN Case Manager – Behavioral Health

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

📋 Description

• Improve the quality of member management, enhance member satisfaction and cost efficiency, and help members navigate the healthcare system.

• Collaborate with clients, members, and healthcare teams to promote wellness and resolve issues.

• Conduct telephonic outreach to both members and providers.

• Gather and analyze data.

• Perform reporting, clinical reviews, medical and behavioral health assessments, and ensure compliant documentation.

• Extract, sort, and analyze data to assess member eligibility for the Population Health Management Program.

• Coordinate and deliver timely, effective, equitable, safe, and member-centered care while adhering to HMO processes.

• Oversee case assignments, including outreach, documentation, monitoring case progress, and case closure.

• Meet reporting and documentation standards, and engage in collaborative meetings with department staff and clients.

• Address barriers, social determinants, member motivators, and psychosocial factors to support wellness and health autonomy.

• Educate members on navigating the HMO and healthcare landscape while advocating for quality and cost-effective interventions and outcomes.

• Support operational activities to fulfill customer requirements and satisfaction.

• Maintain the confidentiality of computer programs, medical records, and data.

• Participate in QM/UM Committee Meetings, including preparation of materials, taking minutes, data collection and analysis, reporting, and follow-up tasks; some meetings may require in-person attendance.

• Be available for off-hour/weekend calls as necessary.

• Pursue ongoing professional growth and education in line with current nursing practices and the Illinois Practice Act.

• Carry out additional responsibilities as assigned in accordance with annual program requirements.

⛳️ Requirements

• Active IL Registered Nurse License.

• Illinois nursing professionals must complete 20 hours of continuing education every 2-year license renewal cycle.

• A minimum of five years of experience across various healthcare settings.

• Extensive experience in Case Management and Chronic Condition Management.

• Understanding of utilization review, quality improvement, managed care, and/or community health.

• Prior remote and/or telephonic work experience.

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

• Experience with motivational interviewing techniques.

• Excellent clinical judgment.

• Highly proficient in both verbal and written communication.

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

• Capability to ensure timely completion of projects and assignments.

• Aptitude to prioritize and adapt to rapidly changing business needs.

• Ability to work independently and remotely, with multitasking skills for fast-paced workflows.

• Proficient in software applications, including word processing and spreadsheets.

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

• Experience with navigating multiple EMRs.

• High-speed, secured home internet connection with a minimum of 100 Mbps download and 10 Mbps upload.

• Private HIPAA-compliant home office equipped with a locking door for security and privacy.

• Backup internet service options available for outages.

🏝️ Benefits

• Fully remote work with a flexible work-from-home arrangement.

• Necessary work equipment provided at no cost.

• Medical, Dental, and Vision insurance plans.

• 401(k) plan with a 3% employer match for the employee’s 6% contribution.

• Life and Disability insurance coverage.

• Options for Voluntary Life insurance.

• Employee Assistance Program (EAP).

• Paid time off plans available.

• Paid parental leave offered.

• Resources for learning and development.

• Virtual meetings and a remote-first work environment.