LOCATION: This is a remote/field position . You must reside within 50 miles of our Richmond, Norfolk, or Roanoke office, and Virginia residency is required.
HOURS: General business hours, Monday through Friday.
TRAVEL: Some visits to a provider or member may be required.
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 or on-site as needed.
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 plan and modifies as necessary.
Interfaces with Medical Directors and Physician Advisors on the development of care management treatment plans.
Assists in problem solving with providers, claims or service issues.
Functions as preceptor for new care management staff.
Works on special projects as assigned by manager.
Other duties as assigned.
Required Qualifications
Requires 3 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.
Current, active, unrestricted RN license from the Commonwealth of Virginia.
Preferred Qualifications
Previous case management experience is preferred.
Behavioral Health and/or experience working with individuals with intellectual/developmental disabilities is a huge plus.
Home health experience, utilization management and/or hospital discharge planning experience is a plus.
