Case Management Nurse - Care Management Programs

**Candidate must reside in Oregon, Washington, Arizona or Nevada**

Position Summary:

Hey there, nursing superheroes! Are you ready to be part of a team that champions patient care and wellness? Our team is looking for a dedicated Case Management Nurse to join our Care Management Programs. Reporting to the Manager of Care Management Programs, you'll play a vital role in delivering exceptional services to our patients. This position operates in line with the collaborative process defined by the Case Management Society of America, focusing on patient safety, high-quality care, and cost-effective outcomes.

Specific Position Requirements & Responsibilities:

• Review program referrals ensuring they align with patient needs and program parameters.
• Be the guiding light! Provide care coordination, educate, and empower patients to manage their conditions effectively.
• Telephonically manage patients' medical conditions, fostering communication between patients and physicians.
• Perform ongoing assessments, planning, coordination, monitoring, and evaluation for each enrolled patient.
• Put on your advocacy hat! Identify and coordinate suitable providers, services, and community resources across the care continuum.
• Conduct utilization management, extending stays or authorizations as required.
• Keep records and create reports that showcase your heroics - detailing interventions and cost savings.

General ICM Employee Requirements & Responsibilities:

• Be the heart of positivity! Build rapport with everyone - from team members to clients and partners - maintaining our culture of patient-first advocacy.
• Help us be our best! Support QA/QI initiatives and help implement our strategic plans.
• Be a guardian of compliance! Follow HIPAA rules, the Code of Conduct, and our Compliance program.

Work Experience, Qualifications, Additional Skills & Abilities, and Professional Competencies:

• 5 years of clinical experience - show us your super skills!
• Communication champ - your verbal and written skills are stellar.
• Tech-savvy - able to navigate various software platforms with ease.
• Independent hero but also a team player - you know how to shine alone and work with others.
• Master problem-solver - you've got the tools to tackle tricky situations with ease.
• Expertise in medical necessity, quality assurance, and patient advocacy - you're the true hero for patients in need.

Education, Licensure, and Certification Requirements:

• RN degree from an Accredited School of Nursing.
• CCM preferred
• High School Diploma or GED.
• Superpower: State-defined Nurse licensure in good standing and the ability to keep up with continued education.

Join our mission to provide exceptional care within our Care Management Programs! We're not just about saving the day; we're about creating a positive work culture where everyone's voice is heard, diversity is celebrated, and teamwork saves lives! Join our mission to humanize the health insurance experience!

This is a remote role, a private and HIPAA compliant workspace is required.

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Job Type: Full-time

Pay: $40.52 - $47.90 per hour

Expected hours: 40 per week

Benefits:

• 401(k)
• Continuing education credits
• Employee assistance program
• Paid sick time

Schedule:

• Monday to Friday

Work setting:

• Remote

Ability to Relocate:

• Arizona: Relocate before starting work (Required)

Work Location: Remote