Nurse Case Manager II

About the role

The Nurse Case Manager II 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. This role performs duties telephonically.

Responsibilities

• 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.
• Captures and coordinates internal and external resources to meet identified needs.
• Makes sure the care management plan is monitored and evaluated for effectiveness and modified as necessary.
• Interacts with Medical Directors and Physician Advisors on the development of care management treatment plans.
• Negotiates rates of reimbursement, as applicable.
• Aids in problem-solving with providers, claims or service issues.
• Aids in the development of utilization/care management policies and procedures.

Requirements

• Requires BA/BS in a health related field and minimum of 5 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.

Qualifications

• BA/BS in a health-related field and minimum of 5 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).
• Multi-state licensure is required if this individual is providing services in multiple states.

Skills

• Preferred: Certification as a Case Manager.

Benefits

• Market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and 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.

Pay

Commensurate with experience.

Schedule

M-F 9am-5:30pm with one 11:30am-8pm shift each week.