RN Case Management - REMOTE
About Our Client: Our client is a trusted leader in healthcare services, dedicated to improving outcomes for patients and providers through innovative solutions and high-quality care. Join a team committed to making a meaningful difference in the lives of those they serve. Role Summary Our client is seeking a dedicated Case Manager to provide exceptional case management services to beneficiaries, focusing on high-quality care and positive outcomes. This role involves screening, assessing, and developing individualized care plans while ensuring compliance with policies and state-specific licensure requirements. The Case Manager will advocate for beneficiaries, manage referrals and authorizations, and collaborate with healthcare providers to meet the needs of those served. Key Responsibilities • Conduct beneficiary screenings and assessments to determine eligibility for case management services. • Develop and implement individualized care plans to address specific needs, goals, and outcomes. • Monitor care plans regularly to ensure relevance and effectiveness, making adjustments as needed. • Provide advocacy for beneficiaries by ensuring access to care and locating specialized services when necessary. • Support beneficiaries with information on resources, including community programs. • Process and review authorization and referral requests, ensuring compliance with policies and high-risk factors. • Maintain detailed and accurate documentation in the medical management system. • Collaborate with providers and internal teams to ensure care plan alignment. • Monitor and provide guidance to non-clinical staff to support operational goals. • Demonstrate consistent reliability and professionalism in attendance and communication. Required Qualifications • Current, unrestricted state license as one of the following: Registered Nurse • A minimum of two years of full-time direct clinical care experience. • Ability to obtain a URAC-recognized certification in case management within four years of hire. • U.S. citizenship with the ability to obtain a favorable Department of Defense (DOD) background investigation. Desired Qualifications • At least two years of case management experience. • Possession of a URAC-recognized case manager certification. Competencies • Technical Skills: Knowledge of case management, HIPAA, URAC standards, policies, and medical coding. • Problem-Solving: Effective analytical skills to address complex care scenarios. • Communication: Excellent verbal and written skills, adaptable to diverse situations. • Organizational Skills: Ability to manage priorities in a fast-paced environment while maintaining attention to detail. • Team Player: Ability to inspire collaboration and positively influence outcomes. Contract to Hire Location: Remote We have openings available across multiple states, including Arkansas, Arizona, California, Colorado, Hawaii, Iowa, Kansas, Missouri, Montana, Nebraska, Nevada, New Mexico, North Dakota, Oklahoma, Oregon, South Dakota, Utah, and Wyoming. Pay is determined based on years of experience and the state of residence. This is an exciting opportunity to join a team dedicated to improving healthcare delivery while advancing your expertise in case mangment. Apply now to make a positive impact and grow your career! #Workwolf