The Telephonic Nurse Case Manager II 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. Hours are Monday - Friday 9:00am to 5:30pm EST and 1 late evening 11:30am to 8:00pm 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 or equivalent experience, current unrestricted RN license in applicable state(s), and multi-state licensure if servicing multiple states. Preferred qualifications include certification as a Case Manager, critical thinking skills, experience with Microsoft Office, ability to manage communications timely, minimum 2 years acute care experience, and minimum 2 years telephonic Case Management experience with a Managed Care Company.
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