Case Manager - Registered Nurse - Southeast Region

About the role

Acts as a liaison with member/client, employer, provider(s), insurance companies, and healthcare personnel as appropriate. Implements and coordinates all case management activities relating to catastrophic cases and chronically ill members/clients across the continuum of care.

Responsibilities

• Assesses and analyzes injured, acute, or chronically ill members/clients medical and/or vocational status; develops a plan of care to facilitate the member/client’s appropriate condition management to optimize wellness and medical outcomes, aid timely return to work or optimal functioning, and determination of eligibility for benefits as appropriate.
• Communicates with member/client and other stakeholders as appropriate (e.g., medical providers, attorneys, employers and insurance carriers) telephonically or in person.
• Prepares all required documentation of case work activities as appropriate.
• Interacts and consults with internal multidisciplinary team as indicated to help member/client maximize best health outcomes.
• Makes outreach to treating physician or specialists concerning course of care and treatment as appropriate.
• Provides educational and prevention information for best medical outcomes.
• Applies all laws and regulations that apply to the provision of rehabilitation services; applies all special instructions required by individual insurance carriers and referral sources.
• Conducts an evaluation of members/clients’ needs and benefit plan eligibility and facilitates integrative functions using clinical tools and information/data.
• Utilizes case management processes in compliance with regulatory and company policies and procedures.
• Facilitates appropriate condition management, optimize overall wellness and medical outcomes, appropriate and timely return to baseline, and optimal function or return to work.
• Develops a proactive course of action to address issues presented to enhance the short and long-term outcomes, as well as opportunities to enhance a member’s/client’s overall wellness through integration.
• Marks member/client progress toward desired outcomes through assessment and evaluation.

Requirements

Candidates must live in the Southeast Region (States Include- FL, GA, AL, MS, NC, SC, TN, AR, LA)

Candidate must have active and unrestricted Compact Registered Nurse (RN) licensure in the state of residence

3+ years clinical practical experience with preference in the following areas: diabetes, Congestive Heart Failure (CHF), Chronic Kidney Disease (CKD), post-acute care, hospice, palliative care, cardiac, home health with Medicare members

2+ years case management, discharge planning and/or home health care coordination experience

2+ years of experience with Microsoft Word, Excel, and Outlook

Preferred Qualifications

• Previous work from home experience in a healthcare related field
• Excellent analytical and problem-solving skills
• Effective communications, organizational, and interpersonal skills
• Ability to work independently
• Certified Case Manager National professional certification (CRC, CDMS, CRRN, COHN, or CCM)
• Efficient and effective computer skills including navigating multiple systems and keyboarding

Education

• Associate's Degree in Nursing or Nursing Diploma (REQUIRED)
• Bachelor's Degree in Nursing (PREFERRED)

License

• Active and unrestricted Compact Registered Nurse (RN) licensure in the state of residence

Pay Range

The Typical Pay Range For This Role Is $60,522.00 - $129,615.00

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors.