Nurse Case Manager I

Nurse Case Manager - Fully Remote Join Insurance Program Managers Group (IPMG) and become part of a dynamic team committed to innovation in insurance! For the past 25 years, our mission has been to create one-of-a-kind insurance solutions for our partners. We bring proactive and tailored approaches to our clients, valuing the unique contribution of each team member. Together, we shape our identity and drive transformative change for our clients. While this is a remote role, candidates must be located in one of the following states: AL, AZ, CA, CT, FL, GA, IL, IN, KY, MA, MI, NY, NC, NH, OH, PA, SC, SD, TN, TX, VA, WI. Position Summary We are looking for a fully remote Registered Nurse for our Nurse Case Manager position. Candidate will need 1+ years of case management experience in which there is a return to work focus and two years full-time equivalent of direct clinical care to the consumer. This position will be a part of a collaborative process of assessment, planning, facilitation, and advocacy for options and services to meet an individual's health and/or disability needs through communication and available resources to promote quality cost-effective outcomes. The position will primarily support short-term disability and workers’ compensation with potential for group health benefits case management. What you will work on Conducts initial and ongoing assessments to identify patient status and individual needs; promotes client self-determination Assists in identifying appropriate providers and facilities throughout the continuum of services, while ensuring that available resources are being used in a timely and cost-effective manner in order to obtain optimum value for both the client and the reimbursement source Utilizes appropriate resources and case management interventions to facilitate the case management plan and to allow for the individual’s optimum level of wellness and functional capability with quality cost-effective outcomes appropriate to health plan and workers’ compensation Develops a specific case management plan in collaboration with the consumer and members of the health care team with periodic updates. Identifies short term goals, long term goals, interventions to meet goals, resources to be utilized, timeframes for re-evaluations, and collaborative approaches to facilitate the case management plan Executes and documents specific case management activities and/or interventions that will lead to accomplishing the goals set forth in the case management plan Gathers sufficient information from all relevant sources and its documentation regarding the case management plan and its activities and/or services to enable the determination of the plan’s effectiveness Evaluates at appropriate intervals, determining and documenting the case management plan’s effectiveness in reaching desired outcomes and goals with modifications, as appropriate Measures and modifies the interventions to determine the outcomes of the case management involvement Implements care plan by facilitating authorizations and referrals, as appropriate, within benefit structure, contractual agreements or jurisdictional regulations; utilizing nationally accepted evidence-based criteria as guidelines for treatment protocols Documents all contacts according to Best Practices, utilizing templates, as required Notifies claims personnel regarding anticipated surgeries, benefit exceptions, and other significant events that may require special handling Manages the disability durations proactively, utilizing nationally accepted evidence-based criteria as guidelines for duration protocols in workers’ compensation and short-term disability Collaborates and communicates effectively with patients/injured workers, providers, client, employers, and internal team members Performs triage intake functions with referrals and coordination of care needs specific to client instructions Performs leave administration and short-term disability management according to regulations, policies, and plan documents What we would like you to join us as a Registered Nurse with Current registered nurse (RN) License 2 years of clinical experience Excellent written and verbal communication skills Proven customer service skills Effective time management skills Overall computer proficiency including expertise in Microsoft Office Suite, especially Outlook, Word, and Excel Licenses and Certifications Licensure or certification in a health or human services discipline that allows the professional to conduct an assessment independently as permitted within the scope of practice of the discipline Two years full-time equivalent of direct clinical care to the consumer At least one of the following: Certification as a case manager from the URAC-approved list of certifications A bachelor’s or higher degree in a health or human services related field A current registered nurse (RN) license Willingness to obtain advanced certification, when eligible Willingness to obtain additional state licensure, as required by business needs Would like for you to have but not required: Advanced/board certification in case management Additional case management/utilization review experience will be considered Travel Occasional travel to clients, our headquarter office in St. Charles, IL for meetings and training, and meeting our business partners. Valid driver's license is required. Core Hours 8:30 a.m. to 5:00 p.m. Monday through Friday. Perks & Benefits Our hours are 8:30-5 Monday through Friday, but we do offer flex hours! Generous Time off. You'll start with 20 days of PTO, paid holidays, paid Birthday off Medical, dental, and vision coverage on day one of full-time employment, including telemedicine if you are on our medical plan 401k match Professional development support and a LinkedIn Learning subscription Flexible time off with an encouraged time away to support a healthy work-life balance Life Insurance, Short term, and long-term disability on day one of full-time employment and paid for by IPMG Onsite fitness center and showers, in our St. Charles, IL HQ office About IPMG Insurance Program Managers Group (IPMG) is a growing insurance organization built on strong relationships, collaboration, and doing right by our clients and our people. We believe that from the front desk to the CEO’s office, everyone plays an equally important role in providing the highest level of service to our clients and independent agent and broker partners. We take pride in our people and that pride is reflected every day in the commitment and effort given by our team. Our hiring process is designed to be a two-way conversation. After your application is received, the process begins with a 20-minute phone conversation to get to learn about your experience, goals, and what you’re looking for next. If that goes well, the next step is a conversation with the hiring manager, and in some cases, other team members. Here you will dive deeper into the role, the team, and how you’d make an impact at IPMG. Candidates that are selected and hired will need to submit to substance, credit, and criminal background screenings, and computer literacy testing. IPMG is an Equal Opportunity Employer—M/F/D/V #J-18808-Ljbffr RH Wine & Co LLC