RN Nurse Case Manager I

Perform care management within the scope of licensure for members with complex and chronic care needs Assess members and develop, implement, coordinate, monitor, and evaluate care plans across the care continuum Perform duties telephonically or on-site, including at hospitals for discharge planning Ensure members understand benefits and assist them in accessing appropriate services Conduct assessments to identify individual needs and care management objectives and goals Implement care plans through education, authorizations, referrals, and extra-contractual arrangements as appropriate Coordinate internal and external resources to meet identified needs Monitor and evaluate care plan effectiveness and modify plans as necessary Interface with Medical Directors and other health professionals on treatment plans Assist members and providers with access to care, vendors, claims, and service issues Requirements BA/BS in a health-related field and a minimum of 3 years of clinical experience, or an equivalent combination of education and experience Current, unrestricted compact RN license in the candidate's home state Multi-state licensure if providing services in multiple states Previous experience with utilization review and/or prior authorization preferred Clinical case management experience in an inpatient or outpatient setting preferred Ability to talk, type, and critically think simultaneously Demonstrated critical thinking skills when interacting with members Experience with Microsoft Office and/or ability to quickly learn new computer programs, systems, and software Ability to manage, review, and respond to emails and instant messages in a timely fashion Excellent collaboration, communication, and teamwork skills Availability Monday through Friday, 8 am to 5 pm local time Core Competencies Demonstrates expertise in care management for members with complex and chronic needs, including the development and implementation of care plans, coordination of resources, and effective communication with healthcare professionals. Holds a current RN license and possesses strong critical thinking and collaboration skills essential for patient advocacy and service access. Highest-signal resume keywords Current RN License Clinical Case Management Experience Utilization Review Experience Care Plan Development Critical Thinking Skills ATS Optimization Keywords Hard Skills Care Management Assessment and Evaluation Care Plan Implementation Discharge Planning Education and Referral Coordination Soft Skills Collaboration Communication Teamwork Critical Thinking Certifications & Qualifications RN License Multi-State Licensure Industry Keywords Chronic Care Management Utilization Review Prior Authorization Inpatient Care Outpatient Care Tools & Technologies Microsoft Office Computer Programs Software Systems #J-18808-Ljbffr Jobtailor