Case Management Nurse

About the role

You will educate members on improving health outcomes, assist with transitions from care settings, participate in process improvement and other pilot programs as they arise, and work with support teams to ensure exceptional care for our members.

You will report into the Associate Director, Clinical.

Responsibilities

• Assist in the coordination of care across a variety of settings (inpatient, outpatient, post acute, ER, home care)
• Actively reach out to members undergoing difficult health challenges and develop care plans
• Proactively reach out to hospital case managers to assist with discharge planning
• Communicate with members via phone or secure messaging to provide education on health conditions, new medications, and procedures.
• Compliance with all applicable laws and regulations
• Other duties as assigned

Requirements

• Active, unrestricted RN licensure from the United States in [state], OR, active compact multistate unrestricted RN license
• Ability to obtain additional state licenses to meet business needs
• 2+ years of clinical experience to include payer, hospital, outpatient or community based care management
• 1+ years of experience in Care Coordination and Navigation

Bonus points

• CCM Certification
• Bilingual in Spanish and/or creole reading, writing, speaking
• BSN
• Working knowledge of Milliman Guidelines