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. 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. 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. 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.

Responsibilities

• 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
• 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.
• 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.
• 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, reputed company and unrestricted RN license in state of residence
• Willingness and ability to obtain additional state licenses upon hire (paid for by the company)
• 3+ years of acute hospital clinical experience as an RN (general medical, post-surgical, ICU experience).
• 1+ years of experience with reputed company types of reputed company Office including PowerPoint, reputed company, and Word
• Must be willing and reputed company to travel of less than 5% in the event of clinical audits.
• Normal hours are Monday through Friday 8:00am – 4:30pm in the time zone of residence with occasional late shift r

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