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: Monday - Friday 9:00am - 5:30pm with 2-4 late evening shifts per month 11:30am to 8pm EST. 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 care plan effectiveness, interfacing with Medical Directors and Physician Advisors, negotiating rates of reimbursement, and assisting in problem solving with providers, claims or service issues. Minimum requirements include a BA/BS in a health-related field and minimum of 3 years of clinical experience or equivalent, current unrestricted RN license in applicable state(s), and multi-state licensure if providing services in multiple states. Certification as a Case Manager is preferred.
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