Case Manager - Care Coordination & Advocacy

Health-One-Alliance,-LLC; Dalton (GA); On-site; USD 60,000 - 90,000; Full time

Benefits offered by this job

401K Match

Health Insurance

Paid Time Off

Short/Long Term Disability

Job summary

HealthOne in Dalton, GA is seeking a licensed RN Case Manager to oversee member care across complex cases and coordinate with providers to ensure efficient utilization of health care benefits.

The role requires an active GA RN license, CCM certification or plan to obtain within 2 years, and 3–5 years of clinical/healthcare experience. Strong HIPAA compliance and MS Office skills are essential.

Qualifications

• 3 years clinical experience required.
• 5 years experience in the health care industry.
• Has current CCM credential or must obtain certification within 2 years of hire.
• PC Skills required (Basic Microsoft Office and E-Mail).
• RN with active license in the state of Georgia or license in their residence if state participates in the Nurse Licensure Compact.

Responsibilities

• Supports utilization management for more complex and non-routine cases.
• Liaises between members, providers, and internal/external customers in coordination of health care delivery and benefits programs.
• Oversees highly complex cases identified through various mechanisms to ensure effective interventions and efficient utilization of benefits.
• Performs essential activities of case management including assessment, planning, implementation, coordinating, monitoring and evaluation of member needs.
• Maintains HIPAA compliance and professional conduct across all duties.

Skills

Case Management

RN License GA

CCM Certification

HIPAA Compliance

Communication

Education

Registered Nurse License (GA)

Tools

Microsoft Office Suite

Email Etiquette

Job description

HealthOne in Dalton, GA is seeking a licensed RN Case Manager to oversee member care across complex cases and coordinate with providers to ensure efficient utilization of health care benefits.

The role requires an active GA RN license, CCM certification or plan to obtain within 2 years, and 3–5 years of clinical/healthcare experience. Strong HIPAA compliance and MS Office skills are essential.