Remote Care Management Nurse

About the role

Work from home within Oregon, Washington, Idaho or Utah
*Please be advised that this role is part of our candidate pool, which allows us to identify and attract exceptional talent for future opportunities. Although we may not have immediate openings, we invite you to submit your resume for consideration. By doing so, you will be included in our database and considered for all suitable positions as they become available, ensuring that you are among the first to be notified of new opportunities that match your skills and experience.

Qualifications

• Nursing or health/human services degree (Associate's or Bachelor's minimum), or equivalent experience in lieu of a degree
• At least 3 years of direct clinical care or experience in case management, utilization management, disease management, auditing, or retrospective review
• Active, unrestricted licensure or certification in a U.S. state or territory that allows you to independently conduct assessments within your scope of practice — RN license required for medical care management
• Must be eligible for licensure in Idaho, Oregon, Utah, and Washington

Skills and attributes

• Knowledge of health insurance industry trends, technology and contractual arrangements
• General computer skills (including use of Microsoft Office, Outlook, internet search)
• Familiarity with health care documentation systems
• Strong oral, written and interpersonal communication and customer service skills
• Ability to interpret policies and procedures, make decisions, and communicate complex topics effectively
• Strong organization and time management skills with the ability to manage workload independently
• Ability to think critically and make decision within individual role and responsibility
• Experience with AI tools and technologies to enhance productivity and decision-making in professional settings highly desired

What you will do

• Conducts case management activities, including assessment, planning, implementation, coordination, monitoring, and evaluation to identify and meet member needs
• Applies clinical expertise and judgment to ensure compliance with medical policy, medical necessity guidelines, and accepted standards of care, utilizing evidence-based criteria and practicing within the scope of their license
• Collaborates with physician advisors, internal and external customers, and other departments to resolve claims, quality of care, member or provider issues, and identifies problems or needed changes, recommending resolutions and participating in quality improvement efforts
• Serves as a resource to internal and external customers, responding to inquiries in a professional manner while protecting confidentiality of sensitive documents and issues
• Provides consistent and accurate documentation, ensuring compliance with performance standards, corporate goals, and established timelines
• Collaborates with other departments to organize, prioritize, and manage assignments to meet goals and timelines
• Maintains and monitors case management plans, gathering sufficient information to determine the plan's effectiveness and making adjustments as needed

Pay

The expected hiring range for a Care Management Nurse is $36.80 – $49.80 per hour, depending on skills, experience, education, and training; relevant licensure/certifications; and performance history. The bonus target for this position is 10%. The current full salary range for this role is $34.20 – $55.70 per hour.