Location: The candidate must live in the state of Maryland.
Schedule: M-F 8:30-5:30pm EST (Telephonic work)
Title: Nurse Case Manager I- ER
The 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.
How you will make an impact as a Nurse Case Manager I:
- Ensuring members 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 the 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.
Nurse Case Manager I Minimum Requirements:
- 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 in Maryland required.
- Multi-state licensure is required if this individual is providing services in multiple states.
Preferred Skills, Capabilities, and Experiences:
- Certification as a Case Manager is preferred.
- For URAC accredited areas the following applies:
- Requires BA/BS and 3 years of clinical care experience; or any combination of education and experience, which would provide an equivalent background.
- Current and active RN license required in applicable state(s). Multi-state licensure is required if this individual is providing services in multiple states. Certification as a Case Manager and a BS in a health or human services related field preferred."