Registered Nurse Case Manager

RN Case Manager I - Telephonic / Field - Northeast KansasField: This field-based role enables associates to primarily operate in the field, traveling to client sites or designated locations as their role requires, with occasional office attendance for meetings or training. This approach ensures flexibility, responsiveness to client needs, and direct, hands-on engagement.Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.This position is not eligible for employment based sponsorship.***Must reside in the state of Kansas. Will support Region 1. ***Travel: 10- 15% travel in Northeast Kansas to visit members in person. Mileage reimbursed.Counties: Will support the counties of Wyandotte, Johnson and Miami.Work Hours: 8am – 5pm, Monday through Friday.The Nurse Case Manager for Kansas Medicaid is responsible for performing care management within the scope of licensure for members with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum. Performs assessments and coordination of care telephonically and occasionally on-site such as at hospitals, community centers, homes, etc for care coordination and discharge planning. Primary duties may include, but are not limited to:Ensures member access to services appropriate to their health needs.Conducts assessments virtually and in person to identify individual needs and a specific care management plan to address objectives and goals as identified during assessment.Implements care plan by facilitating authorizations/referrals as appropriate within benefits structure or through extra-contractual arrangements.Coordinates internal and external resources to meet identified needs.Monitors and evaluates effectiveness of the care management plan and modifies as necessary. Interfaces with Medical Directors and Physician Advisors on the development of care management treatment plans.Negotiates rates of reimbursement, as applicable.Assists in problem solving with providers, claims or service issues.Minimum Requirements:Requires BA/BS in a health-related field and minimum of 3 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.Current, unrestricted RN license in the state of Kansas is required.Preferred Skills, Capabilities and Experiences:Computer proficiency strongly preferred.Job Level: Non-Management ExemptWorkshift: 1st Shift (United States of America)Job Family: MED > Licensed Nurse