Case Manager, Registered Nurse - Fully Remote

Key Responsibilities

• Work intensely as a telephonic case manager with patients and their care team for fully and/or self-insured clients.
• Apply and interpret clinical guidelines, standardized care management plans, and regulatory standards.
• Apply clinical judgment to reduce risk factors and address complex health and social indicators.
• Perform assessments and medical necessity reviews utilizing information from various sources.
• Utilize motivational interviewing skills to ensure maximum member engagement.

Required Qualifications

• 5+ years of experience as a Registered Nurse with at least 1 year in a hospital setting.
• Active, unrestricted RN license in state of residence with willingness to obtain multi-state/compact privileges.
• 1+ years of electronic documentation experience.
• 1+ years of experience in Oncology, Transplant, Specialty Pharmacy, Pediatrics, Medical/Surgical, Behavioral Health/Substance Abuse, or Maternity/Obstetrics.

Education

• Diploma or Associates Degree in Nursing required.