Case Manager, RN

Imagine360; United States; Remote; USD 70,000 - 95,000; Full time

Job summary

Imagine360 is seeking a RN Case Manager to coordinate cost-effective health care resources for CareLink program members in a fully remote role.

The RN will perform assessments, identify cases for interventions, monitor outcomes, and collaborate with providers to optimize care and adherence. This position emphasizes confidentiality, ethics, and quality improvement.

Qualifications

• Registered nurse with active license.
• Experience in case management and coordinating care.
• Familiarity with healthcare reimbursement concepts.

Responsibilities

• Coordinate and facilitate cost-effective care management for CareLink program members.
• Perform assessments and identify cases for interventions.
• Monitor plan effectiveness and adjust as needed.
• Provide customer service and escalate issues as required.
• Participate in quality improvement activities.

Skills

Case management

Motivational interviewing

Healthcare reimbursement concepts

Care coordination

Education

Registered Nurse (RN) License

Job description

Imagine360 is seeking a RN Case Manager to join the team! This position is responsible for coordinating and facilitating cost effective management of health care resources for CareLink program members in order for the member to achieve an optimal outcome in their health. The RN Case Manager utilizes tools and resources to identify individuals and cases for clinical/financial interventions. This position maintains a comprehensive understanding of self-funding and healthcare reimbursement strategies under their scope of responsibility.

Position Start Date: January 2027

Position Location: 100% remote

Responsibilities include but are not limited to:

• Performs essential activities of case management while maintaining members' confidentiality, safety, advocacy, adherence to ethical, legal and accreditation and regulatory standards.
• Performs assessment by identifying members that meet criteria for CareLink Advanced and financial savings programs within the claims department.
• Consistently exercises discretion and judgment to analyze, interpret, make deductions and then decide what actions are necessary based on the varying facts and circumstances of each individual case.
• Determines measurable goals utilizing motivational interviewing and behavior change model and coaches clients while monitoring self-care practices.
• Utilizes industry standard tools to guide individuals with chronic/ongoing health conditions through coaching, assessments, listening, and other techniques as appropriate.
• Executes activities or interventions to achieve the goals in the plan
• Organizes, integrates and modifies the resources needed to reach the goals in the plan.
• Monitors all information from all relevant sources in the plan and its activities and services to determine the plan's effectiveness.
• At repeated intervals, evaluates to determine ultimate effectiveness of plan and modifies plan appropriately to meet the goals.
• Researches medical procedures, treatments and coding when necessary.
• Measures the outcomes of interventions.
• Adheres to practicing the care management core components throughout the continuum of care:
  • Case Management Concepts
  • Case Management Principles and Strategies
  • Psychosocial and Support Systems
  • Healthcare Management and Delivery
  • Healthcare Reimbursement
  • Vocational Concepts and Strategies.
• Customer Service:
  • Acts as a role model in demonstrating the core values in customer service delivery.
  • Provides timely and thorough follow up with, internal and external customers.
  • Appropriately escalates difficult issues up the chain of command.
• Quality Assurance:
  • Serves on committees, work groups, and/or process improvement teams, as assigned, to assist in improving quality/customer satisfaction.
  • Recognizes and alerts appropriate supervisor of trends within their scope of responsibility that fall outside of quality parameters.
  • Performs self-quality monitoring in order to develop and execute plans to meet established goals.
  • Provides ongoing feedback to help optimize quality performance.