Remote Nurse Care Manager (Payer/Insurance Experience Required)

Remote Nurse Care Manager (Payer/Insurance Experience Required) We’re seeking a passionate and highly motivated Nurse Care Manager to join our dynamic Care and Case Management team. In this telephonic role, you'll play a crucial part in holistically guiding our members through their healthcare journey, ensuring their needs are met with industry-leading interventions. This position places a special emphasis on proactive engagement with high‑risk and rising‑risk members, particularly around discharge planning and care transitions. You will partner with a multidisciplinary clinical team—including a variety of healthcare professionals, care coordinators, and records specialists—to deliver integrated remote care in an innovative way. The ideal candidate will enjoy spending time on the phone, actively listening to members’ needs, answering questions, and serving as a dedicated advocate. You should excel at creating cohesive care plans and possess the clinical acumen to guide members through complex situations, leveraging available benefits and resources. Schedule: Remote Responsibilities: Engage in high‑value Care Management outreach calls for Included Health members with the primary goal of clinically engaging high‑risk and rising‑risk members, fostering strong relationships and promoting proactive health management. Make proactive calls to members once their hospital discharge is confirmed, conducting thorough intake assessments if the member is reached. Collaborate with hospital‑based case managers to understand & support members’ specific discharge needs and actively encourage members to engage with our Care Management program. Perform initial assessments encompassing activities of daily living, cognitive functions, social determinants of health (SDOH), health beliefs and behaviors, and life planning activities to develop truly holistic care strategies. Deliver coordinated, patient‑centered virtual Care Management by telephone and/or video that consistently improves members’ health outcomes. Generate impactful care plans collaboratively with members and our multidisciplinary care team, empowering members to achieve their desired health goals. Coordinate necessary resources that holistically address members’ problems, whether clinical or social. Qualifications: Bachelor of Science in Nursing (BSN) Compact Nursing License with additional Active California Registered Nurse (RN) and Illinois License in good standing. 5+ years of experience in clinical nursing 2+ years of experience working in care management, case management, and/or disease management, preferably within a health plan, health navigator, or third‑party administrator (TPA) environment. Remote care or case management experience Comfortable discussing a wide variety of medical conditions and experienced working with populations across all age ranges. Strong comfort with technology and high competence in using multiple computer/medical record systems. Compensation: $38.00/hr - $43.00/hr (Exact compensation may vary based on several factors, including skills, experience, and education.) Benefit packages for this role will start on the 31st day of employment and include medical, dental, and vision insurance, as well as HSA, FSA, and DCFSA account options, and 401(k) retirement account access with employer matching. Employees in this role are also entitled to paid sick leave and/or other paid time off as provided by applicable law. Seniority level: Associate Employment type: Full‑time Job function: Health Care Provider #J-18808-Ljbffr