Case Manager, Registered Nurse
$54,095–$155,538 year
On-siteCheyenne, Wyoming, United States
Job Summary
Conduct telephonic case management for fully and/or self-insured clients by applying clinical judgment to reduce risk factors and address complex health and social indicators. Perform medical necessity reviews, assess benefits, and utilize motivational interviewing skills to guide members through care plans while adhering to regulatory standards and company policies. Consult with supervisors and clinical colleagues to overcome barriers in meeting goals, present cases at multidisciplinary conferences, and escalate member needs according to established protocols. This remote role supports members across multiple states with a focus on Oncology, Transplant, or Specialty Pharmacy experience. Full-time, 40-hour position with a competitive salary range of $54,095 to $155,538.
Required Qualifications
- 5+ years' experience as a Registered Nurse
- at least 1 year of experience in a hospital setting
- active multistate license through the Nurse Licensure Compact (NLC)
- individual, state‐specific RN license for each state they support
- 1+ years' experience documenting electronically using a keyboard
- 1+ years' current or previous experience in Oncology, Transplant, Specialty Pharmacy, Pediatrics, Medical/Surgical, Behavioral Health/Substance Abuse or Maternity/ Obstetrics
- Diploma or Associates Degree in Nursing
Desired Qualifications
- 1+ years' Case Management experience or discharge planning, nurse navigator or nurse care coordinator experience as well as experience with transferring patients to lower levels of care
- 1+ years' experience in Utilization Review
- CCM and/or other URAC recognized accreditation
- 1+ years' experience with MCG, NCCN and/or Lexicomp
- Bilingual in Spanish
- BSN
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