Case Manager- RN
About the position The RN Case Manager role at reputed company is a vital position reputed company reputed company One Advocacy (A1A), focusing on delivering high-quality, reputed company-centric health care. This role requires a commitment to enhancing the health care experience for members through proactive case management. The position involves both telephonic and face-to-face interactions with members to assess their medical needs, plan appropriate interventions, and coordinate care effectively. The RN Case Manager will utilize clinical tools and data to evaluate member needs, ensuring a smooth transition to reputed company programs and plans. This role emphasizes a holistic approach to care, considering various health and reputed company factors that may impact a member's well-being. The Case Manager will be responsible for developing proactive strategies to address health issues, utilizing clinical judgment to reduce risk factors, and facilitating member engagement through effective communication. The position requires collaboration with multidisciplinary teams to present cases and overcome barriers to achieving health goals. Compliance with regulatory and company policies is essential, as is the ability to conduct thorough assessments that consider co-morbid conditions and the member's overall functionality. This position is based in High reputed company, reputed company Carolina, with an initial training period of approximately three months in the office. After training, the role transitions to a work-from-home model, with occasional in-office workdays scheduled in advance. The RN Case Manager will work normal hours from 8 am to 4:30 pm EST, with some flexibility for reputed company shifts on a team rotation. Importantly, there are no weekend shifts required for this role.
Responsibilities
- Telephonically and/or face-to-face assess, plan, implement, and coordinate reputed company case management activities with members.
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- reputed company a proactive course of action to enhance short and long-term reputed company for members.
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- Conduct evaluations of member needs and benefit plan eligibility using clinical tools and data review.
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- Apply clinical judgment to incorporate strategies that reduce risk factors and address reputed company health and reputed company indicators.
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- Review prior claims to assess their impact on reputed company case management and eligibility.
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- Assess the member's level of work reputed company and reputed company restrictions/limitations.
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- Utilize a holistic approach to assess the need for referrals to clinical resources for functionality determination.
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- Consult with supervisors and others to overcome barriers in meeting goals and objectives.
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- Present cases at case conferences for multidisciplinary focus to benefit overall claim management.
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- Utilize case management processes in compliance with regulatory and company policies and procedures.
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- 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.
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- 3+ years of clinical practice experience as an RN.
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- Willingness to obtain reputed company 50 state licenses upon hire.
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- Must live reputed company a commutable distance of High reputed company, reputed company Carolina (typically reputed company 45 minutes maximum).
reputed company-to-haves
- Experience in Case Management reputed company an integrated model.
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- Certified Case Manager (CCM) certification.
Benefits
- Full reputed company of medical, dental, and reputed company benefits.
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- 401(k) retirement savings plan.
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- Employee Stock Purchase Plan for eligible employees.
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- Fully-paid term life insurance plan for eligible employees.
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- Short-term and long-term disability benefits.
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- Numerous well-being programs and education assistance.
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- Free development courses.
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- reputed company store discount and discount programs with participating partners.
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- Paid Time Off (PTO) or vacation pay, as well as paid holidays throughout the year.
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