Senior Registered Nurse Case Manager

Job Description

Immediate need for a talented Senior Registered Nurse Case Manager. This is a 06+months contract opportunity with long-term potential and is located in Durham, NC(Onsite). Please review the job description below and contact me ASAP if you are interested.

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Job ID: 26-31454

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Pay Range: $30/hr - $37/hour. Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location).

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Key Responsibilities:

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• Serve as a team member on a multidisciplinary team, coordinating care, resources, and services for members to achieve optimal clinical and resource outcomes.
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• Utilize applicable clinical skillset and perform comprehensive assessments to collaborate with members, families, internal partners, and external providers on treatment plans.
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• Develop a member-centric plan tailored to individual needs, health status, and support requirements; identify barriers to achieving goals.
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• Utilize community resources and funding sources in the development of care plans.
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• Perform ongoing monitoring and management of members, including scheduled follow-ups and assessments of progress towards goals.
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• Evaluate and facilitate care provided through various settings, including physician offices, hospitals, and home care.
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• Educate members and encourage proactive interventions to limit expenses and promote positive outcomes.
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• Document all aspects of the care plan from initial assessment to outcome evaluation.
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• Outreach to high-risk, high-cost, or high-utilization members as needed.
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• Review alternative treatment plans and assess benefits eligibility.
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• Evaluate medical necessity and appropriateness of services as defined by department standards.
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• Develop relevant policies, procedures, and training materials as needed.
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Key Requirements and Technology Experience:

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• RN license in North Carolina with 3+ years of clinical and/or case management experience required.
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• Must have and maintain a valid and applicable clinical license (NC or compact multi-state licensure).
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• For some roles, additional specialty certification (i.e., CCM, CDCES) may be required within 2 years of employment.
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• Nice to have: Master’s in Social Work with 5 years of related experience; applicable licensure for Behavioral Health roles with a minimum of 3 years of clinical experience.
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Our client is a leading Insurance Industry, and we are currently interviewing to fill this and other similar contract positions. If you are interested in this position, please apply online for immediate consideration.

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Pyramid Consulting, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

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