The Telephonic Nurse Case Manager II is responsible for 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. Hours are Monday - Friday 9 - 5:30 pm EST, plus 3 times a month 11:30 - 8 pm EST. Multi-State Licensure is required as the position services members in different states. Responsibilities include ensuring member access to appropriate services, conducting assessments, implementing care plans, coordinating resources, monitoring and evaluating care plans, interfacing with Medical Directors and Physician Advisors, negotiating reimbursement rates, assisting with provider and claims issues, and contributing to utilization/care management policies and procedures. Minimum requirements include a BA/BS in a health-related field with at least 5 years clinical experience or equivalent, and a current unrestricted RN license in applicable state(s). Certification as a Case Manager and a BS in a health or human services related field are preferred. The position supports members in multiple states and requires multi-state licensure.
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