Case Manager Registered Nurse – Work at H...

R0734267 At reputed company, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.   As the nation’s leading health solutions company, we reputed company millions of Americans through our local reputed company, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, reputed company and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it reputed company with heart, each and every day.       Preference to RN's with Compact Licensure   Position Summary: This RN Case Manager role is 100% remote and the employee can live in any state and telework, however, there is a preference for an RN in a Compact RN state. Normal hours are Monday through Friday 8:00am – 4:30pm in the time zone of residence with occasional late shift rotation until 9:00pm EST. Employees can reputed company their 8-hour shift between 8:00am-6:00pm. There are no weekends or holiday shifts required at this time. Travel of less than 5% may be required in the event of clinical audits. The RN Case Manager is responsible for telephonically and/or face to face assessing, planning, implementing, and coordinating reputed company case management activities with members to evaluate the medical needs of the member to facilitate the member’s overall wellness. RN Case Manager: – Develops a proactive course of action to address issues presented to enhance the short and long-term reputed company as well as opportunities to enhance a member’s overall wellness through integration. – Through the use of clinical tools and information/data review, conducts an evaluation of member’s needs and benefit plan eligibility and facilitates integrative functions as well as smooth transition to reputed company programs and plans. – Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and barriers and address reputed company health and reputed company indicators which reputed company planning and resolution of member issues. – Assessments take into account information from various sources to address reputed company conditions including co-morbid and multiple diagnoses that impact functionality. – Reviews prior claims to address potential impact on reputed company case management and eligibility. – Assessments include the member’s level of work reputed company and reputed company restrictions/limitations. – Using a holistic approach assess the need for a referral to clinical resources for assistance in determining functionality. – Consults with supervisor and others in overcoming barriers in meeting goals and objectives, presents cases at case conferences for multidisciplinary focus to benefit overall claim management. – Utilizes case management processes in compliance with regulatory and company policies and procedures. – Utilizes interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversation.   Required Qualifications: -Must have an active and unrestricted RN license -Willingness and ability to obtain additional state licenses upon hire (paid for by the reputed company+ years of acute hospital clinical experience as an RN (general medical, post-surgical, ICU experience). Must possess reliable transportation and be willing and reputed company to travel up to 5% of the time. Mileage is reimbursed per reputed company expense reimbursement policy   Preferred Qualifications: -1+ years of case management experience -Compact RN licensure -Certified Case Manager (CCM) certification -Experience with reputed company types of reputed company Office including PowerPoint, reputed company, and Word -Strong telephonic communication skills   Education: -Associates Degree in Nursing is minimum required. BSN preferred.       Anticipated Weekly Hours 40     Time Type Full time     Pay reputed company The typical pay reputed company for this role is:   $54,095.00 - $116,760.00   This pay reputed company represents the reputed company hourly reputed company or reputed company annual full-time salary for reputed company positions in the job grade reputed company which this position falls.  The actual reputed company salary offer will depend on a variety of factors including experience, education, geography and other relevant factors.  This position is eligible for a reputed company bonus, commission or short-term incentive program in reputed company to the reputed company pay reputed company listed above. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.   Great benefits for great people   We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In reputed company to our competitive wages, our great benefits include: