Case Manager- RN
About the position
Responsibilities
• Telephonically and/or face-to-face assess, plan, implement, and coordinate all case management activities with members.
• Develop a proactive course of action to enhance short and long-term outcomes for members.
• Conduct evaluations of member needs and benefit plan eligibility using clinical tools and data review.
• Apply clinical judgment to incorporate strategies that reduce risk factors and address complex health and social indicators.
• Review prior claims to assess their impact on current case management and eligibility.
• Assess the member's level of work capacity and related restrictions/limitations.
• Utilize a holistic approach to assess the need for referrals to clinical resources for functionality determination.
• Consult with supervisors and others to overcome barriers in meeting goals and objectives.
• Present cases at case conferences for multidisciplinary focus to benefit overall claim management.
• Utilize case management processes in compliance with regulatory and company policies and procedures.
• Engage members through effective interviewing skills to discern their health status and needs.
Requirements
• Registered Nurse with an unrestricted license in their state of residence, with multi-state/compact privileges.
• 3+ years of clinical practice experience as an RN.
• Willingness to obtain all 50 state licenses upon hire.
• Must live within a commutable distance of High Point, North Carolina (typically within 45 minutes maximum).
Nice-to-haves
• Experience in Case Management within an integrated model.
• Certified Case Manager (CCM) certification.
Benefits
• Full range of medical, dental, and vision benefits.
• 401(k) retirement savings plan.
• Employee Stock Purchase Plan for eligible employees.
• Fully-paid term life insurance plan for eligible employees.
• Short-term and long-term disability benefits.
• Numerous well-being programs and education assistance.
• Free development courses.
• CVS store discount and discount programs with participating partners.
• Paid Time Off (PTO) or vacation pay, as well as paid holidays throughout the year.
Apply Now
Apply Now
Responsibilities
• Telephonically and/or face-to-face assess, plan, implement, and coordinate all case management activities with members.
• Develop a proactive course of action to enhance short and long-term outcomes for members.
• Conduct evaluations of member needs and benefit plan eligibility using clinical tools and data review.
• Apply clinical judgment to incorporate strategies that reduce risk factors and address complex health and social indicators.
• Review prior claims to assess their impact on current case management and eligibility.
• Assess the member's level of work capacity and related restrictions/limitations.
• Utilize a holistic approach to assess the need for referrals to clinical resources for functionality determination.
• Consult with supervisors and others to overcome barriers in meeting goals and objectives.
• Present cases at case conferences for multidisciplinary focus to benefit overall claim management.
• Utilize case management processes in compliance with regulatory and company policies and procedures.
• Engage members through effective interviewing skills to discern their health status and needs.
Requirements
• Registered Nurse with an unrestricted license in their state of residence, with multi-state/compact privileges.
• 3+ years of clinical practice experience as an RN.
• Willingness to obtain all 50 state licenses upon hire.
• Must live within a commutable distance of High Point, North Carolina (typically within 45 minutes maximum).
Nice-to-haves
• Experience in Case Management within an integrated model.
• Certified Case Manager (CCM) certification.
Benefits
• Full range of medical, dental, and vision benefits.
• 401(k) retirement savings plan.
• Employee Stock Purchase Plan for eligible employees.
• Fully-paid term life insurance plan for eligible employees.
• Short-term and long-term disability benefits.
• Numerous well-being programs and education assistance.
• Free development courses.
• CVS store discount and discount programs with participating partners.
• Paid Time Off (PTO) or vacation pay, as well as paid holidays throughout the year.
Apply Now
Apply Now