Telephonic Nurse Case Manager, I

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

📋 Description

• Deliver telephonic care management services within the limits of licensure for members with intricate and chronic healthcare needs.

• Evaluate member requirements and create tailored care management strategies.

• Execute care plans by securing authorizations and referrals within the benefits framework or through alternative contractual agreements.

• Coordinate both internal and external resources to address identified needs.

• Monitor and assess the effectiveness of care plans, making adjustments as necessary.

• Guarantee member access to services that align with their health requirements.

• Collaborate with Medical Directors and Physician Advisors regarding care management treatment strategies.

• Support problem-solving related to providers, claims, or service issues.

• Aid in the development of utilization and care management policies and procedures.

⛳️ Requirements

• BA/BS in a health-related discipline.

• Minimum of 3 years of clinical experience, or a combination of education and experience that provides a comparable background.

• Current, unrestricted RN license issued by the State of Georgia.

• Multistate licensure is required when delivering services across multiple states.

• Capability to speak and type simultaneously.

• Case Manager certification is preferred.

• Strong critical thinking abilities when engaging with members.

• Proficient in Microsoft Office and/or quick to learn new computer programs, systems, and software.

• Capacity to manage, review, and respond to emails and instant messages promptly.

• Must be a resident of the State of Georgia.

• Should be within a reasonable commuting distance from the job location unless accommodations are made.

• Completion of an online pre-employment skills assessment within 48 hours of receipt, meeting the assessment criteria.

🏝️ Benefits

• Merit-based salary increases.

• Paid holidays.

• Paid Time Off.

• Incentive bonus opportunities.

• Medical benefits.

• Dental benefits.

• Vision benefits.

• Short-term disability coverage.

• Long-term disability coverage.

• 401(k) plan with matching contributions.

• Stock purchase plan.

• Life insurance coverage.

• Wellness programs.

• Financial education resources.

• Virtual full-time work arrangement, except for mandatory in-person training sessions.