Case Manager Registered Nurse (Remote)
Core
Deliver comprehensive case management services via telephonic and face-to-face interactions to assess, plan, and coordinate care strategies for members' medical needs.
Role type
Registered Nurse Case Manager
Builds
Proactive care plans addressing short- and long-term health outcomes
Domain
Healthcare / Managed Care
Required skills
Clinical judgment, Holistic assessment, Prior claims review, Work capacity evaluation, Multidisciplinary collaboration, Regulatory compliance
Preferred skills
Behavioral Health experience, Certified Case Manager, Managed care experience, Telephonic communication, Time management
Technologies
Microsoft Office 365, EHR portals, VPN, Teams, Outlook, Excel
Responsibilities
Evaluate member eligibility and identify health risks, Conduct holistic assessments considering co-morbidities and social determinants, Review prior claims and determine referral needs, Collaborate with supervisors and teams to optimize care planning
Seniority
Mid-level, hands-on IC