Nurse Case Manager I
Location
United States
Posted
6 days ago
Salary
Not specified
Job Description
Role Description
The Telephonic Nurse Case Manager I is responsible for 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 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 management plan and modifies as necessary.
- Interfaces with Medical Directors and Physician Advisors on the development of care management treatment plans.
- Negotiates rates of reimbursement, as applicable.
- Assists in problem solving with providers, claims or service issues.
- Assists with development of utilization/care management policies and procedures.
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 RN license in applicable state(s) required.
- Multi-state licensure is required if this individual is providing services in multiple states.
Requirements
- Certification as a Case Manager is preferred.
- BS in a health or human services related field preferred.
- Kentucky RN License.
Benefits
- Market-competitive total rewards including merit increases, paid holidays, and Paid Time Off.
- Incentive bonus programs (unless covered by a collective bargaining agreement).
- Medical, dental, vision, short and long term disability benefits.
- 401(k) + match.
- Stock purchase plan.
- Life insurance.
- Wellness programs and financial education resources.
Job Requirements
- 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 RN license in applicable state(s) required.
- Multi-state licensure is required if this individual is providing services in multiple states.
- Certification as a Case Manager is preferred.
- BS in a health or human services related field preferred.
- Kentucky RN License.
Benefits
- Market-competitive total rewards including merit increases, paid holidays, and Paid Time Off.
- Incentive bonus programs (unless covered by a collective bargaining agreement).
- Medical, dental, vision, short and long term disability benefits.
- 401(k) + match.
- Stock purchase plan.
- Life insurance.
- Wellness programs and financial education resources.
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