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 8:30am - 5:00pm with 2-3 late evening shifts per week 11:30am to 8:00pm EST. Multi-State Licensure is required as this position services members in different states. Responsibilities include ensuring member access to appropriate services, conducting assessments, implementing care plans, coordinating resources, monitoring and evaluating care plans, interfacing with Medical Directors and Physician Advisors, negotiating reimbursement rates, 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 Case Manager certification, critical thinking skills, experience with Microsoft Office, acute care setting experience, telephonic case management experience with a Managed Care Company, and managed care experience.
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