Case Manager - Registered Nurse

• Acts as a liaison with member/client /family, employer, provider(s), insurance companies, and healthcare personnel as appropriate. 

• Implements and coordinates all case management activities relating to catastrophic cases and chronically ill members/clients across the continuum of care that can include consultant referrals, home care visits, the use of community resources, and alternative levels of care. 

• Interacts with members/clients telephonically or in person. May be required to meet with members/clients in their homes, worksites, or physician’s office to provide ongoing case management services.

• Assesses and analyzes injured, acute, or chronically ill members/clients medical and/or vocational status; develops a plan of care to facilitate the member/client’s appropriate condition management to optimize wellness and medical outcomes, aid timely return to work or optimal functioning, and determination of eligibility for benefits as appropriate.  

• Communicates with member/client and other stakeholders as appropriate (e.g., medical providers, attorneys, employers and insurance carriers) telephonically or in person.

• Prepares all required documentation of case work activities as appropriate.

• Interacts and consults with internal multidisciplinary team as indicated to help member/client maximize best health outcomes.

• May make outreach to treating physician or specialists concerning course of care and treatment as appropriate.

• Provides educational and prevention information for best medical outcomes.

• Applies all laws and regulations that apply to the provision of rehabilitation services; applies all special instructions required by individual insurance carriers and referral sources.

• Conducts an evaluation of members/clients’ needs and benefit plan eligibility and facilitates integrative functions using clinical tools and information/data. 

• Utilizes case management processes in compliance with regulatory and company policies and procedures. 

• Facilitates appropriate condition management, optimize overall wellness and medical outcomes, appropriate and timely return to baseline, and optimal function or return to work. 

• Develops a proactive course of action to address issues presented to enhance the short and long-term outcomes, as well as opportunities to enhance a member’s/client’s overall wellness through integration. 

• Monitors member/client progress toward desired outcomes through assessment and evaluation. 

Required Qualifications

• Candidate must reside in an Eastern Standard Time Zone (EST) state

• Candidate must have active and unrestricted Compact Registered Nurse (RN) licensure in state of residence

• ​2+ years of experience in care management

• 2+ years of Medicare experience

Preferred Qualifications

• Geriatric experience

• Experience working in a Multicultural setting, or person multicultural experience

• Certified Case Manager

• National professional certification (CRC, CDMS, CRRN, COHN, or CCM)

Education

• Associate’s Degree in Nursing AND relevant experience in a health care-related field (REQUIRED)

• Bachelor’s Degree in Nursing (PREFERRED)

License

• Active and unrestricted Compact Registered Nurse (RN) licensure in state of residence