Description
**LOCATION: This is a remote opportunity and you must be within 50 miles of our Hanover, Maryland office. Maryland residency is required.**
**HOURS: General business hours, Monday through Friday: 8:30 am - 5:30 pm**
**TRAVEL: Occasional visits to the office may be required for team meetings or training.**
The Nurse Case Manager I is responsible for performing care management within the scope of licensure for members with complex and chronic care. Responsible for those members at highest risk for a rapid readmission, thus promptly engaging them to assess and address red flags, improve the quality of care, and allow for real-time oversight. Performs duties telephonically.
Primary duties may include, but are not limited to:
Ensures member access to services appropriate to their health needs.
Conducts assessments to identify individual needs and a specific care management plan to address objectives and goals as identified during assessment.
Implements care plan by facilitating authorizations/referrals as appropriate within benefits structure or through extra-contractual arrangements.
Coordinates internal and external resources to meet identified needs.
Monitors and evaluates effectiveness of the care management plan and modifies as necessary.
Interfaces with Medical Directors and Physician Advisors on the development of care management treatment plans.
Negotiates rates of reimbursement, as applicable.
Assists in problem solving with providers, claims or service issues.
**Required Qualifications**
Requires BA/BS in a health related field and minimum of 3 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.
Current, unrestricted RN license from the state of Maryland is required.
**Preferred Qualifications**
Previous obstetrics experience is preferred.
Previous experience as a case manager is preferred.
Previous Medicaid and/or Managed Care experience is very helpful.
Compensation Information:
$0.0 / - $0.0 /
Starting At: 0.0
Up To: 0.0
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