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Role Description

The Nurse Case Manager I is responsible for performing care management within the scope of licensure for members with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum. Performs duties telephonically or on-site as needed.

• Ensures member access to services appropriate to their health needs.
• Conducts assessments to identify individual needs and a specific care management plan to address objectives and goals as identified during assessment.
• Implements care plan by facilitating authorizations/referrals as appropriate within benefits structure or through extra-contractual arrangements.
• Coordinates internal and external resources to meet identified needs.
• Monitors and evaluates effectiveness of the care plan and modifies as necessary.
• Interfaces with Medical Directors and Physician Advisors on the development of care management treatment plans.
• Assists in problem solving with providers, claims or service issues.
• Functions as preceptor for new care management staff.
• Works on special projects as assigned by manager.
• Other duties as assigned.

Qualifications

• Requires 3 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.
• Current, active, unrestricted RN license issued by the state in which you reside is required.
• As this position supports multiple states, compact or multi-state licensure is required.

Requirements

• Previous case management experience is preferred.
• Home health experience, utilization management and/or hospital discharge planning experience is a plus.

Benefits

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