Nurse Care Manager I

Role Overview

• Collaborating with healthcare providers and/or consumers to drive personalized health management
• Performing care management activities within the scope of licensure for members with complex and chronic care needs
• Ensuring medically appropriate, high quality, cost effective care
• Assessing the medical necessity of inpatient admissions and extensions of stay, outpatient services, out of network services
• Interpreting appropriateness of care, intervention planning, and general clinical guidance in partnership with physician clinical reviewers and/or medical directors
• Collaborating with providers to assess consumer needs for early identification of and proactive planning for discharge
• Conducting clinical assessment to develop goals that address individual needs in order to develop and implement a care plan
• Monitoring and evaluating effectiveness of the care management plan and modifying as necessary

Requirements

• Requires a HS diploma or equivalent
• Minimum of 3 years of acute care clinical experience
• Current, active valid unrestricted RN license in applicable state(s) required
• Multi-state licensure required if providing services in multiple states
• Home health/discharge planning experience preferred
• AS or BS in nursing preferred
• Certification as a Case Manager is preferred
• Critical care (ICU, Emergency Care, strong Medical Surgical background) preferred
• Requires 3 years full-time equivalent of direct clinical care experience to the consumer
• 5 years full-time equivalent of direct clinical care experience to the consumer preferred

Benefits

• Merit increases
• Paid holidays
• Paid Time Off
• Incentive bonus programs
• Medical, dental, vision benefits
• Short and long term disability benefits
• 401(k) + match
• Stock purchase plan
• Life insurance
• Wellness programs
• Financial education resources