RN Concierge Care Manager – Medical Case Management

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

📋 Description

• Oversee daily high-touch member management, including the execution of program objectives, treatment plan coordination, and benefit management for high-risk patient populations or members with intricate conditions.

• Organize clinical services in collaboration with providers, vendors, facilities, social workers/case managers, and community resources.

• Engage in team training and ongoing medical education.

• Prepare for external audits and quality assurance initiatives.

• Deliver concierge case management for members in specialized programs such as high-risk maternity, NICU, ESRD, Cancer, Palliative Care, or Behavioral Health.

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

• Develop personalized care plans that promote cost-effectiveness, care satisfaction, and enhanced quality of life.

• Educate and assist members with prior authorizations, medication adherence, and their individualized care plans.

• Handle member interactions primarily through phone and messaging systems for those with chronic, high-risk, or inpatient conditions.

⛳️ Requirements

• Associate's degree in nursing OR graduate from an accredited nursing school OR a master's degree in social work, psychology, or counseling.

• 5 years of case management experience as an RN OR 2 years of case management experience as an RN within a health insurance setting.

• Proficient in word processing software.

• Familiarity with quality improvement processes and proven ability in these areas.

• Understanding of contract language and its application.

• Capability to work independently, prioritize 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.

• Analytical or creative thinking abilities.

• Capacity to manage confidential or sensitive information with discretion.

• Proficient in Microsoft Office.

• Active, unrestricted RN licensure from the United States and in the state of hire; OR an active, compact, multistate, unrestricted RN license as outlined by the Nurse Licensure Compact (NLC); 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 as a Case Manager.

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

• Preferred: 5 years of experience in case management within a sub-specialty area.

• Preferred: Familiarity with Microsoft Word, PowerPoint, Excel, or other spreadsheet/database software; TMCS, LiveOps, MDDS, and BlueVue.

• Preferred: Case manager certification, clinical certification in specialty area, BLS or ACLS certification.

🏝️ 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 at major locations.

• Education assistance.

• Service recognition.

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