RN Medical Case Manager

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

📋 Description

• Deliver thorough, member-focused care for individuals facing complex and chronic health conditions, including those with high-risk diagnoses.

• Employ a proactive, advocacy-oriented approach to assist members effectively.

• Collaborate with multidisciplinary teams to coordinate care, eliminate obstacles, and enhance health outcomes.

• Promote cost-effective use of services and minimize unnecessary emergency department and inpatient admissions.

• Manage a diverse and evolving caseload.

• Assist with utilization management functions for more intricate and non-standard cases as required.

• Act as a liaison among members, providers, and both internal and external customers to facilitate healthcare delivery and benefits programs.

• Supervise highly complex cases to guarantee effective execution of interventions and optimal use of benefits.

• Conduct case management tasks, including assessment, planning, implementation, coordination, monitoring, outcomes, and evaluation.

• Communicate through digital platforms and provide technical support as needed.

⛳️ Requirements

• Active Registered Nurse (RN) license in the state of Tennessee or a license in the state of residence if it participates in the Nurse Licensure Compact Law.

• Minimum of 3 years of clinical experience is required.

• At least 5 years of experience within the healthcare industry.

• For Select Community & Katie Beckett: 2 years of experience in Intellectual and Developmental Disabilities (IDD) for Select Community is mandatory.

• Exceptional oral and written communication abilities.

• Proficiency in PC skills (Basic Microsoft Office and Email).

• Strong technical capabilities.

• Competence in effectively communicating through digital channels and providing technical assistance.

• Ability to evaluate and manage complex needs in both telephonic and digital settings.

• Skill in navigating care across the entire continuum.

• Capability to engage members effectively to promote adherence and improve outcomes.

• Openness to utilizing enterprise-approved digital and AI tools.

• Digital literacy assessment is required.

• Various immunizations and/or related medical tests may be necessary.

🏝️ Benefits

• Employee position.

• Various immunizations and/or related medical tests may be necessary for this role.