Case Manager- RN

About the position Responsibilities • Telephonically and/or face-to-face assess, plan, implement, and coordinate all case management activities with members. • Develop a proactive course of action to enhance short and long-term outcomes for members. • Conduct evaluations of member needs and benefit plan eligibility using clinical tools and data review. • Apply clinical judgment to incorporate strategies that reduce risk factors and address complex health and social indicators. • Review prior claims to assess their impact on current case management and eligibility. • Assess the member's level of work capacity and related restrictions/limitations. • Utilize a holistic approach to assess the need for referrals to clinical resources for functionality determination. • Consult with supervisors and others to overcome barriers in meeting goals and objectives. • Present cases at case conferences for multidisciplinary focus to benefit overall claim management. • Utilize case management processes in compliance with regulatory and company policies and procedures. • Engage members through effective interviewing skills to discern their health status and needs. Requirements • Registered Nurse with an unrestricted license in their state of residence, with multi-state/compact privileges. • 3+ years of clinical practice experience as an RN. • Willingness to obtain all 50 state licenses upon hire. • Must live within a commutable distance of High Point, North Carolina (typically within 45 minutes maximum). Nice-to-haves • Experience in Case Management within an integrated model. • Certified Case Manager (CCM) certification. Benefits • Full range of medical, dental, and vision benefits. • 401(k) retirement savings plan. • Employee Stock Purchase Plan for eligible employees. • Fully-paid term life insurance plan for eligible employees. • Short-term and long-term disability benefits. • Numerous well-being programs and education assistance. • Free development courses. • CVS store discount and discount programs with participating partners. • Paid Time Off (PTO) or vacation pay, as well as paid holidays throughout the year. Apply tot his job Apply To this Job