Case Management Nurse

EXL; Utah; Remote; USD 49,593 - 59,236; Full time

Job summary

A prominent healthcare company is seeking a Case Management Nurse to conduct comprehensive assessments and develop care plans for beneficiaries. The ideal candidate will have 5+ years of clinical RN experience and a current RN license. Responsibilities include coordinating care and collaborating with healthcare providers to ensure optimal health outcomes. This position is full-time and allows for remote work within the United States. Competitive salary and benefits are included.

Qualifications

• Current, unrestricted RN license in state of residence with multi-state privileges.
• 5+ years of clinical RN experience in direct patient care.
• Knowledge of case management practices and patient-centered care concepts.

Responsibilities

• Conduct a comprehensive assessment with beneficiaries.
• Develop and document a case management care plan.
• Coordinate and implement activities specified in the care plan.

Skills

Clinical RN experience

Case management practices

Proficiency in Microsoft Office

Adaptability to changing priorities

Education

Associate or bachelor's degree in nursing

Tools

Microsoft Office

Job description

Case Management Nurse

Location: US Remote

Base Pay Range: $36.00 - $43.00 per hour plus bonus

Estimated Travel: Up to 10% for training

Must be a US Citizen

For more information on benefits and what we offer please visit us at https://www.exlservice.com/us-careers-and-benefits

Seniority level: Associate

Employment type: Full-time

Job function: Education

Industries: Public Health and Business Consulting and Services

Responsibilities

• Conduct a comprehensive assessment with beneficiaries and analyze assessment findings to identify and prioritize clinical, psychosocial, and behavioral concerns and potential gaps in care.
• Develop and document a case management care plan in direct collaboration with the beneficiary, the beneficiary's family or significant other(s), the primary physician and other health care providers. Identify and include key concerns, needs, and preferences of the beneficiary and family/caregiver.
• Document identified issues, prioritized and individualized goals (long & short term), evidence-based interventions, collaborative approaches and resources, anticipated time frames, and barriers to achieving goals in the care plan.
• Coordinate and implement the activities specified in the care plan to provide optimal benefits coverage as well as promote continuity of care and integration of services for the beneficiary across care transitions. Collaborate and communicate with the beneficiary, family, significant other(s), physician, and other health care providers to accomplish the goals on the care plan.
• Initiate care conferences with Medical Director and/or the multidisciplinary care team to discuss challenging beneficiary cases and obtain expert clinical opinion or consultation.
• Serve as beneficiary advocate by promoting self‑determination, informed and shared decision‑making, autonomy, and self‑advocacy for beneficiaries. Empower beneficiaries by providing education and support to reinforce self‑care management, facilitate access to care, and promote optimal health outcomes.
• Identify relevant benefit‑related, educational, and health care resources for beneficiaries. Facilitate coordination of care with existing community‑based programs and services to meet the identified needs of the beneficiary.
• Demonstrate and apply knowledge of the philosophy/principles of comprehensive case management, patient‑centered, culturally sensitive care coordination, and management of complex conditions throughout the case management process.
• Collaborate with beneficiaries and their support system/caregivers, providers, the multi‑disciplinary team, and health care and community resources throughout the case management process.
• Document appropriate clinical information and data in a timely, accurate, and concise manner consistent with applicable standards of practice.

Qualifications

Required

• Current, unrestricted RN license in state of residence with multi‑state privileges (an active compact state license)
• Must hold United States citizenship status
• Ability to obtain Security Clearance required. Current DOD Security Clearance preferred
• Associate or bachelor's degree in nursing from an accredited institution. Bachelor’s degree preferred
• 5+ years of clinical RN experience in direct patient care
• Knowledge of case management practices and patient‑centered care concepts
• Proficiency in Microsoft Office, mobile technologies and navigating multiple applications
• Ability to adapt to changing priorities

Preferred

• 1+ years of prior case management experience
• Case Management Certification highly desirable (CCM preferred)
• Experience working in an NCQA accredited case management program
• Experience as a telephonic case manager at a health plan highly desirable