This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more.

Role Description

The Telephonic RN 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.
• Performing duties telephonically or on-site such as at hospitals for discharge planning.

How you will make an impact:

• Ensures members understand benefits and assist in access of 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 through actions based on assessments including providing education, 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 management plan and modifies as necessary.
• Interfaces with Medical Directors and other health professionals on the development of care management treatment plans.
• Assists in problem solving for members and providers related to access to care, vendors, claims or service issues, etc.

Qualifications

• Requires BA/BS in a health related field and minimum of 3 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.
• Current, unrestricted compact RN license in your home state.
• Multi-state licensure is required if this individual is providing services in multiple states.

Requirements

• Strong clinical background in hospital setting, i.e. Med Surg, ER, ICU, Critical Care.
• Ability to talk, type and critically think at the same time.
• Demonstrates critical thinking skills when interacting with members.
• Experience with Microsoft Office and/or ability to learn new computer programs/systems/software quickly.
• Ability to manage, review and respond to emails/instant messages in a timely fashion.
• Excellent collaboration, communication and teamwork skills.

Benefits

• Comprehensive benefits package.
• Incentive and recognition programs.
• Equity stock purchase.
• 401k contribution (all benefits are subject to eligibility requirements).