RN Case Manager

About the role

The RN Case Manager is responsible for creating, implementing, and monitoring treatment plans to assist patients/members in meeting their healthcare goals. They assess the member's health status and care coordination needs, including inpatient review and discharge planning, outpatient management, and contact with various stakeholders.

Responsibilities

• Assess the member’s health status and care coordination needs
• Contact with patient, family, physicians, additional health care providers, and community resources
• Contact with provider business offices and with the employer/client
• Identify alternative treatment plans and coordinate care within cost containment guidelines
• Monitor the health status and the impact of the treatment plan for each client
• Develop and implement Case Management goals, both short and long term, with documented care plans
• Evaluate the cost-effectiveness of the elected treatment plan and report outcomes
• Interpret individual health plans and authorize/coordinate care in accordance with plan provisions

Requirements

• 5+ years related work experience with a professional background in clinical nursing and patient assessment
• Related Bachelor’s degree or additional related equivalent work experience
• Graduate of an accredited school of nursing
• RN - Registered Nurse - State Licensure Compact State Licensure in good standing
• Knowledgeable in medical terminology, reasonable and necessary treatment plans, delivery quality health care services, and cost containment practices
• Ability to collaborate with cross-operational areas within the organization

Preferred

• Certified Case Manager (CCM)
• Prior experience in utilization management or case management, preferably within the managed care environment
• Intensive care or higher-acuity patient experience
• Knowledge of managed care in a self-funded employer population
• Ability to identify and address issues such as underutilization or overutilization of services
• Ability to promote and maintain quality care through analysis

What We Can Offer YOU!

• Comprehensive benefits package including medical, dental, vision, life, and global travel health insurance
• Income protection benefits: life insurance, Short- and long-term disability programs
• Leave programs to support personal circumstances
• Retirement Savings Plan with employer contribution and match
• Paid time off, volunteer time off, and 11 holidays
• Additional voluntary benefits and a comprehensive wellness program

General Physical Demands

Sedentary work: Exerting up to 10 pounds of force occasionally to move objects. Jobs are sedentary if traversing activities are required only occasionally.