Registered Nurse (RN) – Case Manager - Virginia
Registered Nurse (RN) – Case Manager
Location: Remote (Must reside in Virginia) Compensation: $46.66 per hour Licensure: Active, unrestricted Virginia RN License required
Role Overview
As a Case Manager, you will play a pivotal role in advocating for members by facilitating a collaborative process of assessment, planning, and advocacy. You will utilize clinical tools and data to identify member needs, evaluate benefit plans, and ensure cost-effective, high-quality outcomes.This is a sedentary, fast-paced role that relies heavily on clinical expertise, regulatory compliance, and digital proficiency.
Key Responsibilities- Comprehensive Assessments: Conduct detailed reviews of referred members' needs and eligibility using clinical tools and data.
- Case Resolution: Determine the best approach for meeting member needs by evaluating internal/external programs and benefit plans.
- Regulatory Compliance: Apply and interpret standardized case management plans, policies, and regulatory standards to ensure the appropriate administration of benefits.
- Quality Management: Utilize established case management and quality processes in strict accordance with accreditation guidelines and company procedures.
- Advocacy: Serve as a bridge between members and healthcare resources to promote optimal health outcomes.
- Education/Licensure: Must be a Registered Nurse with an active, unrestricted VA license.
- Clinical Experience: Minimum of 3 years of clinical practice (e.g., hospital, home health, or ambulatory care).
- Industry Knowledge: Experience in healthcare and/or the managed care industry.
- Case Management: Prior experience in Case Management is highly preferred.
- Technical Skills: Proficiency in navigating multiple computer systems, high-speed keyboarding, and managing digital documentation.
- Communication: Exceptional verbal and written communication skills for member advocacy and internal reporting.
- Adaptability: Ability to multitask and prioritize effectively in a fast-paced, evolving environment.
- Critical Thinking: Strong ability to interpret complex criteria and guidelines.
- Setting: Typical office/remote environment with high productivity and quality expectations.
- Physical Demands: This is a sedentary role requiring extended periods of sitting, talking on the phone, and typing.
- Visual Acuity: Must be able to perform close inspections of handwritten documents, computer-generated reports, and PC monitors.
Are you ready to use your clinical expertise to make a difference in member care? Apply today.
Pay Details: $46.66 per hour
Benefit offerings available for our associates include medical, dental, vision, life insurance, short-term disability, additional voluntary benefits, EAP program, commuter benefits and a 401K plan. Our benefit offerings provide employees the flexibility to choose the type of coverage that meets their individual needs.In addition, our associates may be eligible for paid leave including Paid Sick Leave or any other paid leave required by Federal, State, or local law, as well as Holiday pay where applicable.
Equal Opportunity Employer/Veterans/Disabled
Military connected talent encouraged to apply
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The Company will consider qualified applicants with arrest and conviction records in accordance with federal, state, and local laws and/or security clearance requirements, including, as applicable:
- The California Fair Chance Act
- Los Angeles City Fair Chance Ordinance
- Los Angeles County Fair Chance Ordinance for Employers
- San Francisco Fair Chance Ordinance
Massachusetts Candidates Only: It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.