RN Concierge Care Manager – Maternity, NICU

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

📋 Description

• Deliver care management services to members both in South Carolina and nationwide.

• Provide comprehensive, high-touch concierge case management for specialized programs such as high-risk maternity, NICU, ESRD, Cancer, Palliative Care, and Behavioral Health.

• Identify potential risks and conduct outreach to coordinate healthcare services and bridge care gaps.

• Develop personalized care plans aimed at enhancing cost-effectiveness, care satisfaction, and overall quality of life.

• Oversee daily high-touch member management, including setting program goals, developing treatment plans, and coordinating benefits.

• Collaborate with clinical services, providers, vendors, facilities, social workers/case managers, and community services.

• Educate and support members in navigating prior authorizations, medication adherence, and plan-of-care requirements.

• Manage members with chronic or high-risk conditions and those with inpatient admissions via phone and messaging platforms.

• Engage in team training and ongoing medical education.

• Prepare for external audits and quality assurance initiatives.

⛳️ Requirements

• Associate’s degree in nursing OR a graduate of an accredited nursing school OR a master’s degree in social work, Psychology, or Counseling.

• Minimum of 5 years' experience in case management OR at least 2 years’ experience as a case manager in a health insurance setting.

• Proficient in word processing software.

• Familiarity with quality improvement processes and demonstrated capability in these activities.

• Understanding of contract language and its application.

• Ability to work independently, prioritize tasks effectively, and make informed decisions.

• Proven customer service, organizational, and presentation skills.

• Strong proficiency in spelling, punctuation, and grammar.

• Excellent oral and written communication skills.

• Ability to persuade, negotiate, or influence others effectively.

• Skills in analytical or creative thinking.

• Capability to handle confidential or sensitive information with discretion.

• Proficiency in Microsoft Office.

• Active, unrestricted RN license from the United States and in the state of hire; OR an active, compact, multistate, unrestricted RN license under the Nurse Licensure Compact; OR active licensure as a social worker, psychologist, or counselor in the state of hire.

• Nationally recognized Case Management certification must be obtained within 2 years of hire.

• Preferred: 5 years’ experience in Maternity/NICU.

• Preferred: Bachelor's degree in a health-related field.

• Preferred: Working knowledge of Microsoft Word, PowerPoint, Excel, TMCS, LiveOps, MDDS, and BlueVue.

• Preferred: Certification in case management, clinical certification in a specialty area, and BLS or ACLS certification.

• Fully remote work requires high-speed non-satellite internet and a private, secure home office.

• Availability Monday-Friday from 8:00 am to 5:00 pm EST.

🏝️ Benefits

• Subsidized health plans.

• Dental and vision coverage.

• 401k retirement savings plan with company match.

• Life Insurance.

• Paid Time Off (PTO).

• On-site cafeterias and fitness centers in major locations.

• Education Assistance.

• Service Recognition.

• National discounts for movies, theaters, zoos, theme parks, and more.

• Reasonable accommodations for individuals with disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs.