RN Case Manager
$91,770–$112,174 year
RemoteMassachusetts, United States
Job Summary
Facilitate care for members with rising health risks or complex needs by assessing disparities, social determinants, and barriers to optimize outcomes. Engage members in appropriate care plans, coordinate services, and promote compliance through shared decision-making and education. Interpret case management criteria to create and document comprehensive plans, review medication lists for complex pharmacy needs, and counsel on side effects. Connect with treatment providers, PCPs, and facilities to gather clinical information, monitor quality concerns, and make appropriate referrals while understanding insurance products and regulatory requirements. Work independently within a team of medical and behavioral health professionals to support seamless care transitions.
Required Qualifications
- Active licensure in Massachusetts is required, appropriate to position (RN/PT)
- 3-5 years relevant experience in a variety of appropriate clinical health care settings (Inpatient, outpatient, or differing levels of care)
- Ability to identify and document member-driven, specific, measurable activities that address actionable behaviors and goals
- Self-directed, independent, adaptive, flexible to change, and able to collaborate as a member of a team
- Proficient with multiple IT systems
- Demonstration of awareness, attitude, knowledge, and skills needed to work effectively with a culturally and demographically diverse population
- High school degree or equivalent
Desired Qualifications
- Utilization Management experience, preferred
- Licensure in additional states a plus
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