Case Manager, Registered Nurse

Role Overview

• working intensely as a telephonic case manager with patients and their care team for fully and/or self-insured clients
• application and/or interpretation of applicable criteria and clinical guidelines, standardized care management plans, policies, procedures and regulatory standards while assessing benefits and/or member’s needs
• applies clinical judgment to incorporate strategies designed to reduce risk factors and barriers and address complex health and social indicators impacting care planning
• assessments utilize information from various sources to address all conditions
• consults with supervisor and others in overcoming barriers in meeting goals and objectives
• presents cases at case conferences for multidisciplinary focus
• uses a holistic approach, consults with clinical colleagues, supervisors, Medical Directors and/or other programs to overcome barriers
• utilizes case management processes in compliance with regulatory and company policies and procedures
• utilizes motivational interviewing skills to ensure maximum member engagement
• identifies and escalates member’s needs appropriately following set guidelines and protocols
• actively reaches out to members to collaborate/guide their care
• perform medical necessity reviews

Requirements

• 5+ years’ experience as a Registered Nurse
• at least 1 year of experience in a hospital setting
• 1+ years’ experience documenting electronically using a keyboard
• 1+ years’ current or previous experience in Oncology, Transplant, Specialty Pharmacy, Pediatrics, Medical/Surgical, Behavioral Health/Substance Abuse or Maternity/ Obstetrics experience
• A RN who resides in a compact state must have an active multistate license through the Nurse Licensure Compact (NLC)
• Nurses residing in non‑compact states must hold an individual, state‑specific RN license for each state they support

Benefits

• medical, dental, and vision coverage
• paid time off
• retirement savings options
• wellness programs
• other resources