Telephonic Nurse Case Manager, II

This is a fully remote position, open to applicants in Florida, +3 more states.

📋 Description

• Deliver telephonic care management for members with intricate and chronic care requirements within the scope of your licensure.

• Evaluate member needs and create tailored care management plans.

• Execute care plans by facilitating authorizations and referrals within benefit frameworks or through non-contractual arrangements.

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

• Monitor and assess the effectiveness of care plans, making modifications as needed.

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

• Ensure that members have access to the necessary health services.

• Negotiate reimbursement rates where applicable.

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

• Support the development of utilization and care management policies and procedures.

⛳️ Requirements

• BA/BS in a health-related discipline and a minimum of 5 years of clinical experience; or a combination of education and experience that provides an equivalent background.

• A current, unrestricted RN license in the applicable state is required.

• Multi-state licensure is necessary when offering services in various states.

• Experience in Case Management.

• Certification as a Case Manager is required.

• At least 2 years of experience in an acute care environment.

• Familiarity with Managed Care.

• Capability to converse and type simultaneously.

• Strong critical thinking skills when engaging with members.

• Proficiency in Microsoft Office and/or the ability to quickly learn new computer programs, systems, and software.

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

• Must complete the online pre-employment skills assessment within 48 hours of receipt and meet the established criteria.

• Must live within a reasonable commuting distance from the job location(s), unless an accommodation is provided as required by law.

• Availability to work Monday–Friday from 9:00am–5:30pm EST and one late evening from 11:30am–8:00pm EST.

• Multi-State Licensure is required to serve members in different states.

🏝️ Benefits

• Comprehensive benefits package.

• Incentive and recognition programs.

• Equity stock purchase options.

• 401k contribution.

• Merit increases.

• Paid holidays.

• Paid Time Off.

• Incentive bonus programs.

• Medical benefits.

• Dental benefits.

• Vision benefits.

• Short-term disability benefits.

• Long-term disability benefits.

• 401(k) with matching contributions.

• Stock purchase plan.

• Life insurance.

• Wellness programs.

• Financial education resources.

• Virtual work flexibility.

• Required in-person training sessions.

• COVID-19 and Influenza vaccination support/requirement for certain roles.