NEW JOB OPENING
REGISTERED NURSE (RN) CASE MANAGER - REMOTE
IN Remote, USA!

Required Education:

• High School Diploma or Equivalent



Required License/Certification:

• Unrestricted active RN Compact license



Preferred License/Certification:

• Case Management Certification (CCM)



Required Qualifications/Skills/Experience:

• 3 years of clinical practice experience, such as hospital, home health, or ambulatory care

• Case management experience

• Healthcare and/or managed care industry experience

• Previous experience working in a remote position

• Proficiency with computer skills, including navigating multiple systems and keyboarding

• Effective verbal and written communication skills

• Ability to multitask, prioritize, and adapt effectively to a fast-paced, changing environment

• Ability to work independently in a remote environment

• Private, separate office space free from distractions due to HIPAA compliance

• Ability to sit for extended periods while talking on the telephone and working on a computer



Registered Nurse (RN) Case Manager – Remote Overview:

• The Registered Nurse (RN) Case Manager – Remote utilizes a collaborative process of assessment, planning, facilitation, and advocacy to identify options and services that meet an individual's benefit plan and/or healthcare needs

• Through effective communication and the use of available resources, the Case Manager works to promote optimal, cost-effective outcomes

• The role requires an RN with an unrestricted active Compact license and involves comprehensive assessment of referred members' needs and eligibility

• Using clinical tools and information/data review, the Case Manager determines appropriate approaches for case resolution and evaluates available benefits, internal programs, and external services

• The position requires the application and interpretation of applicable criteria, guidelines, standardized case management plans, policies, procedures, and regulatory standards to ensure appropriate administration of benefits

• The Case Manager also utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures



Job Duties

• Conduct comprehensive assessments of referred members' needs and eligibility using clinical tools and information/data review

• Determine appropriate approaches for case resolution and meeting member needs

• Evaluate member benefit plans and available internal and external programs and services

• Apply and interpret applicable criteria, guidelines, policies, procedures, and regulatory standards

• Utilize standardized case management plans to support appropriate administration of benefits

• Utilize case management and quality management processes in accordance with regulatory and accreditation guidelines

• Advocate for options and services that support individual healthcare and benefit needs

• Communicate effectively with members and available resources to promote optimal, cost-effective outcomes

• **Only those lawfully authorized to work in the designated country associated with the position will be considered.**

• **Please note that all Position start dates and duration are estimates and may be reduced or lengthened based upon a client’s business needs and requirements.**