RN Case Manager

About This Role

The Case Manager, an RN, coordinates referrals for high-risk members and provides education on illnesses and treatments. This role manages clinical operations, medical management activities, and facilitates communication among healthcare providers, members, and health plans.

Responsibilities

• Collaborates with physicians and multidisciplinary teams to develop and maintain coordinated care plans.
• Acts as a liaison between members and the healthcare team to ensure effective communication and alignment of care plans.
• Assists physicians, members, and families in obtaining referrals to specialists.
• Provides counseling and support tailored to the clinical needs of the member.
• Creates comprehensive member-centric care plans that include member-driven goals and interventions.
• Partners with designated physicians to create and maintain individualized Member Care Plans.
• Actively participates in developing and deploying Coordination of Care activities aimed at enhancing the clinical experience.
• Facilitates communication among care team members to address the needs of both the member and the physician.
• Provides education to members on health management and maintenance for optimal health outcomes.
• Educates members and care team participants about available community and health plan benefits and services.

Requirements

• Bachelor of Science in Nursing (BSN) or 5 years case management experience
• Unrestricted current RN licensure in Connecticut, New Jersey, or Pennsylvania
• 2+ years of experience in health plan case management (complex and disease)
• Experience in a remote and telephonic role
• Proficient in Microsoft Office and Adobe products
• Ability to travel to home office as necessary

Qualifications

• Bachelor of Science in Nursing (BSN), or 5 years case management experience in lieu of BSN
• 2+ years of experience in health plan case management, complex and disease case management, and experience in a remote and telephonic role. 5 years case management experience can substitute for a BSN.

Nice to Have

• BSN
• Case Management experience
• Experience in discharge planning
• Experience in utilization review, concurrent review, or risk management
• Proven background in managed care

Skills

* Required skills

Benefits

Certifications