Telephonic Case Manager RN

About This Role

This role will support a diverse member population by providing education, advocacy, and connecting them to necessary resources. You will directly improve health outcomes by aiding people with care, pharmacy benefits, data, and resources.

Responsibilities

• Make outbound calls to assess members' current health status
• Identify gaps or barriers in treatment plans
• Provide patient education to assist with self-management
• Interact with Medical Directors on challenging cases
• Coordinate care for members
• Make referrals to outside sources
• Coordinate services as needed (home health, DME, etc.)
• Educate members on disease processes
• Encourage members to make healthy lifestyle changes
• Document and track findings
• Make Welcome Home calls to ensure that discharged members receive the necessary services and resources

Requirements

• Current unrestricted Compact License
• Ability to obtain CCM certification within 18 months of employment or currently a Certified Case Manager (CCM)
• Ability to present member case stories to consultants twice a year either onsite in Arizona or virtually
• 3+ years of experience as a Registered Nurse in a hospital setting, acute care, direct care experience or experience as a telephonic Case Manager for an insurance company
• Ability to navigate a Windows environment, utilize Outlook, and the ability to create, edit, save and send documents utilizing Microsoft Word
• Private home office and access to high-speed Internet (Fiber Optic/Cable)

Qualifications

• 3+ years of experience as a Registered Nurse in a hospital setting, acute care, direct care, or as a telephonic Case Manager for an insurance company

Nice to Have

• Bachelor's Degree
• Certified Case Manager (CCM)
• Case management experience
• Disease management experience
• Discharge planning experience
• Background in managed care
• Based in the Phoenix, Arizona area, able to come to the local office for meetings as needed

Skills

* Required skills

Benefits

Certifications