The Telephonic Nurse Case Manager I 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 duties telephonically. This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. Work schedule is Monday – Friday 9:00am - 5:30pm with 2-4 late evening shifts per month 11:30am to 8pm depending on your time zone. Multi-State Licensure is required as this position services members in different states. Responsibilities include ensuring member access to services appropriate to their health needs, conducting assessments to identify individual needs and specific care management plans, implementing care plans by facilitating authorizations/referrals, coordinating internal and external resources, monitoring and evaluating care plan effectiveness, interfacing with Medical Directors and Physician Advisors, negotiating rates of reimbursement, and assisting in problem solving with providers, claims or service issues. Minimum requirements include a BA/BS in a health-related field and minimum of 3 years clinical experience or equivalent, current unrestricted RN license in applicable state(s), and multi-state licensure if providing services in multiple states. Preferred certification as a Case Manager. The position offers a salary range of $68,880 to $118,080 for candidates working in person or virtually in California, Colorado, and New York, along with a comprehensive benefits package.
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