Nurse Case Manager (Remote Position)

Job Summary

As a First Choice Health (FCH) Nurse Case Manager, you will work with members, providers, and multidisciplinary team members to assess, facilitate, plan, and coordinate an integrated delivery of care across the continuum. You will work to ensure members progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service.

Job Duties

• Completes an initial and ongoing assessment of the patient’s current medical situation, pertinent past medical history, as well as a psychosocial assessment.
• Provides pertinent patient education materials to aid the member in shared decision making.
• Collaborates with the member, caregiver, and their providers to create a prioritized patient-centered care plan to optimize member’s self-care management.
• Makes sure the effectiveness of the member’s case management plan is monitored and evaluated, and works with the member/family to adjust as needed.
• Facilitates communication and coordination among the health care team to minimize fragmentation, eliminate duplication, and maximize delivery of appropriate care.
• Engages and manages members enrolled in various disease-specific programs such as Bariatrics, Transplant, Baby Steps, Transgender, and Complex/Catastrophic Case Management.
• Creates member correspondence using plain language and ensures compliance with internal policies and procedures.
• Represents First Choice Health in professional organizations or meetings.
• Completes month-end updates and case management notes for invoicing by the established date.
• Identifies and refers patients to behavioral health, stop loss, subrogation, external vendors for health and wellness services based on the appropriate guidelines and payor requirements.
• Maintains productivity and quality standards.
• Adheres to department and corporate policies and procedures.
• Performs other projects or duties as assigned.

Qualifications

• Registered Nurse (RN) required.
• Current, unrestricted RN license in state of residence and after successfully completing a 90-day orientation period, must begin applications for licensure in additional states with FCH footprint within 6 months of hire (compact state highly preferred).
• CCM or related case management certification preferred or recommended.
• Strong clinical background with at least 5 years of direct patient care.
• 3-5 years Case Management experience.
• Prefers experience working in the healthcare payer industry (ie. TPA, HMO, or PPO), disease management, discharge planning, telephonic case management, complex case management, and utilization review.
• Strong physical assessment skills.
• Strong organizational, time management, and interpersonal skills.
• Proficiency in PC Applications including Google and Microsoft applications.
• Prefers experience with Interqual Guidelines, NCCN, and Casetrakker.
• Demonstrates analytical ability to identify problems, develop solutions, and implement a course of action within an acceptable interpretation of departmental policies and procedures.
• Professional demeanor, functions well in stressful situations, and prioritizes well with minimal direction.

About First Choice Health

First Choice Health, headquartered in Seattle, WA, is a provider-owned healthcare organization offering employers a forward-thinking alternative to traditional health insurance. We have been serving employers of all sizes and across many industries with exceptional health benefits administration for over 35 years, providing unparalleled access to a growing number of clinically integrated networks (CIN) and a traditional PPO. Alongside our Employee Assistance Program (EAP) addressing mental health and work-life balance, our services collectively support members in every step of their healthcare journeys. At First Choice Health, we are proud to deliver the personalized, quality service our clients deserve, while reducing costs and keeping their members healthy.

Our Purpose, Values & Culture

CARE TRANSPARENT COLLABORATE RELENTLESS INNOVATE

Physical Requirements

• Ability to see and hear within normal ranges with or without aid.
• Ability to bend, and move within normal ranges.
• Ability to be stationary for long periods of time.
• Finger and hand dexterity.
• Ability to lift a minimum of 10-20 lbs.

Access to PHI

Routine & re-occurring access to all forms of PHI – The duties of the position require regular and unrestricted contact with PHI.

BENEFITS

• Medical & Vision: Two medical plans for employees, High Deductible and PPO plan for employees to choose from.
• Dental: A dental plan through Delta dental is available to employees and eligible dependents.
• Health Savings Account (HSA): Employees who enroll in our medical plan can choose to establish a health savings account if eligible. FCH makes contributions to the HSA and employees may contribute pre-tax dollars via payroll deduction up to the IRS allowable limits.
• Flexible Spending Account (FSA): Employees may contribute pre-tax dollars through payroll deduction to a limited vision/dental FSA. Unlike with an HSA, unused FSA funds do not rollover from year to year.
• Life Insurance: FCH provides life insurance benefits at no cost at a limit of two times an employee’s annual base salary (with a max of $300,000). Employees have the opportunity to purchase additional life insurance for themselves and their dependents through payroll deduction.
• Short & Long-Term Disability Insurance: FCH provides long-term and short-term disability coverage to all employees. It is a shared cost benefit where FCH pays for the long-term benefit and employees pay for the short-term benefit.
• Personal Leave and Sick Time: FCH employees enjoy the benefit of paid time off. Vacation, sick leave, and any personal leave are combined into a general annual PTO bank. PTO accruals are based on service on a pay period: 0-1 year of service – 120 hours; 1-2 years of service – 136 hours; 3 + years of service – 168 hours.
• Paid Holidays: Each employee receives 13 paid holidays. 16 hours per year are available for community services, usable in four-hour or eight-hour time blocks.
• Employee Assistance Program (EAP): FCH recognizes that a variety of problems can disrupt personal and work life. If an employee needs professional help, they can contact the EAP, which provides confidential access to professional counseling services for help in confronting personal problems such as alcohol/substance abuse, marital and family difficulties, financial or legal troubles, or emotional distress.
• Retirement Plan 401(k): We contribute 50% of the employee’s 401k deferral, up to a maximum of 3% of the employee’s gross salary. Eligible employees must be at least 21 years old, and be employed with FCH a minimum of 90 days.
• Tuition Reimbursement: Employees may be eligible to receive reimbursement for continuing education for Bachelor’s program after one year of employment with the company.
• Wellness: We encourage and promote healthy behaviors through a Wellness program that offers rewards for those that participate.