Case Management Nurse I (Remote Eligible)
RemoteUnited States
Job Summary
Utilize critical thinking to recognize signs and symptoms of high-risk conditions, proactively anticipate member needs, and design unique, individualized care plans that avoid service duplication. Discuss care needs with members and families through supportive interventions, partner with healthcare providers and community resources to coordinate services, and educate members on their personal accountabilities and available benefits. Document care management activities accurately and timely while complying with regulatory standards and internal guidelines. This remote-eligible role requires flexibility for weekend and holiday hours on a rotational basis. Candidates must obtain a Certified Case Manager (CCM) certification within 24 months of hire and maintain it throughout employment.
Required Qualifications
- Completion of an accredited nursing program
- Active and unrestricted RN License in Iowa or South Dakota
- Certified Case Manager (CCM); must obtain within 24 months of hire
- 4+ years of diverse clinical experience (e.g., acute care, outpatient, home health, etc.) that reflects 4+ years of direct clinical care to the consumer
- Experience in utilization management or health insurance setting beneficial
- Strong verbal communication skills; influences action and facilitates crucial conversations regarding care with members, physicians, and care facilities
- Maintains courtesy and professionalism when engaging with members, internal and external stakeholders
- Strong written communication skills, including accurate documentation of events within the case management platform; ensures quality and consistency by following guidelines and processes
- Commitment to service excellence and member advocacy; uses critical thinking and problem-solving skills to anticipate member and provider needs
- Resourceful self-starter who demonstrates strong understanding of resources, processes, and guidelines. Able to make independent decisions or recommendations under ambiguity
- Ability to organize and manage multiple priorities in a dynamic work environment where quality and/or production goals are measured. Commitment to timeliness, follow up, accuracy and attention to detail
- Flexible and adapts to change
- Strong technical acumen; learns new systems quickly - e.g., Microsoft Office, clinical documentation platforms, etc.
- Knowledge of standards and regulations - e.g., URAC, NCQA, HIPAA, PHI confidentiality
- Must be flexible and have the ability work weekend and/or holiday hours when needed on a rotational basis
- Must have high-speed internet at their work location
Desired Qualifications
- Candidates located in Iowa or South Dakota preferred
- Top candidates will have prior health plan experience along with a diverse clinical background, including behavioral health experience
- Certified Case Manager (CCM)
- Care navigation/care coordination experience strongly preferred
- Behavioral health experience
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