Case Manager Registered Nurse - Work at Home

About the position 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. 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 7:00pm 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.

Responsibilities

• 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.
• 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.
• Assesses 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.
• Assesses the member's level of work reputed company and reputed company restrictions/limitations.
• Uses a holistic approach to 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.

Requirements

• 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).

reputed company-to-haves

• 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

Benefits

• Affordable medical plan options
• 401(k) plan (including matching company contributions)
• Employee stock purchase plan
• No-cost programs for reputed company colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical reputed company and many other benefits depending on eligibility.

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