Case Management Nurse
Job Summary
The Case Management Nurse will educate members on improving health outcomes and assist with transitions from various care settings. You will participate in process improvement programs and work collaboratively with support teams. The role focuses on ensuring exceptional care through proactive communication and coordination.
Responsibilities
- Coordinate care across inpatient and outpatient settings
- Develop care plans for members with health challenges
- Collaborate with hospital case managers on discharge planning
- Educate members on health conditions and medications
Required Skills
- Active unrestricted RN licensure
- 2+ years clinical/case management experience
- 1+ years care coordination experience
- Strong communication and navigation skills
Job Details
Responsibilities:
- Assist in the coordination of care across a variety of settings (inpatient, outpatient, post acute, ER, home care)
- Actively reach out to members undergoing difficult health challenges and develop care plans
- Proactively reach out to hospital case managers to assist with discharge planning
- Communicate with members via phone or secure messaging to provide education on health conditions, new medications, and procedures.
- Compliance with all applicable laws and regulations
- Other duties as assigned
Requirements:
- Active, unrestricted RN licensure from the United States in [state], OR, active compact multistate unrestricted RN license
- Ability to obtain additional state licenses to meet business needs
- 2+ years of clinical experience to include payer, hospital, outpatient or community based care management
- 1+ years of experience in Care Coordination and Navigation
Bonus points:
- CCM Certification
- Bilingual in Spanish and/or creole reading, writing, speaking
- BSN
- Working knowledge of Milliman Guidelines