RN Case Manager – Transition of Care, Bilingual Spanish

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

📋 Description

• Ensure that members have access to services that align with their health requirements.

• Identify, evaluate, and manage members according to established guidelines.

• Implement care plans by facilitating authorizations and referrals within the benefits framework or through additional contractual arrangements.

• Utilize independent judgment to assess the appropriateness of authorizations and allocate both internal and external resources to meet identified needs.

• Monitor and assess the effectiveness of care management plans and adjust them as needed.

• Collaborate with Primary Care Physicians, Hospitalists, Nurse Practitioners, and specialists regarding care management treatment strategies.

• Negotiate reimbursement rates, as necessary.

• Assist in resolving provider, claims, or service-related issues.

• Evaluate the effectiveness of interventions to ascertain case management outcomes.

• Engage in and provide insights on utilization and care management policies and procedures.

• Counsel and involve patients and their families regarding available care options, assisting in determining suitable and preferred courses of action.

• Conduct duties primarily through telephonic communication.

⛳️ Requirements

• A minimum of 5 years of clinical case management experience, or an equivalent combination of education and experience.

• An Associate's or Bachelor's degree in Nursing.

• A current, unrestricted RN license in the state of application.

• Strong ability to communicate positively, professionally, and effectively with others; capable of providing leadership, teaching, and collaborating with colleagues.

• Excellent written and verbal communication skills; ability to build and maintain constructive relationships with diverse members, management, staff, and vendors.

• Strong problem-solving, organizational, and time management skills, with the ability to thrive in a fast-paced environment.

• Capability to fulfill the essential physical functions, including standing, walking, sitting, using hands and fingers, reaching, talking, hearing, lifting and moving up to 10 pounds, close vision, and adjusting focus.

🏝️ Benefits

• Comprehensive health and wellness programs.

• Opportunities for professional development and advancement.

• Competitive salary and performance-based incentives.

• Flexible work arrangements to promote work-life balance.