The Telephonic Nurse Case Manager I is responsible for performing care management within the scope of licensure for members with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum. Performs duties telephonically. This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. Work schedule is Monday - Friday 9:00am to 5:30pm with 1-2 late evenings 11:30am to 8:00pm depending on your time zone. This position will service members in different states; therefore Multi-State Licensure will be required. Responsibilities include ensuring member access to services appropriate to their health needs, conducting assessments to identify individual needs and a specific care management plan, implementing care plans by facilitating authorizations/referrals, coordinating internal and external resources, monitoring and evaluating effectiveness of care management plans, interfacing with Medical Directors and Physician Advisors, assisting in problem solving with providers, claims or service issues, and assisting with development of utilization/care management policies and procedures. Minimum requirements include a BA/BS in a health-related field, 3 years of clinical experience or equivalent, current unrestricted RN license in applicable state(s), and multistate licensure if providing services in multiple states. Preferred skills include ability to talk and type simultaneously, certification as a Case Manager, critical thinking skills, experience with Microsoft Office or ability to learn new software quickly, and ability to manage and respond to emails/instant messages timely.
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