Case Manager RN (Remote)

Health Plans, Inc.; Manchester (NH); Remote; USD 60,000 - 90,000; Full time

Job summary

Health Plans, Inc. is seeking a dedicated Case Manager RN to join their team. This remote role focuses on providing comprehensive care coordination and support to members navigating the healthcare system. The ideal candidate will have a strong clinical background, excellent assessment skills, and a passion for promoting quality care and patient advocacy. Join us to make a real difference in the lives of individuals and families across the nation.

Benefits

Medical benefits

Flexible Spending Account

401(k) with Quarterly Bonuses

Generous Paid-Time Off

Educational Assistance

Qualifications

• 3+ years of clinical experience required.
• Experience in Discharge Planning and/or Case Management is essential.
• Familiarity with URAC standards and healthcare regulations.

Responsibilities

• Conduct utilization management using standardized clinical criteria.
• Develop individualized case management plans.
• Consult with Physician Reviewers on appropriateness of care.

Skills

Utilization management

Patient assessment

Care coordination

Self-management education

Education

Active Registered Nurse (RN) license

Tools

Windows-based computers

Job description

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Case Manager RN at HPI

Do you envision working for a company that has the expertise of a long-standing industry leader, but the spirit of an entrepreneur? Does the thought of making a real impact motivate and energize you? If so, HPI is the place for you. Join a team that values integrity, flexibility, loyalty, compassion and dedication—we can’t wait to meet you.

Case Manager RN at HPI

Do you envision working for a company that has the expertise of a long-standing industry leader, but the spirit of an entrepreneur? Does the thought of making a real impact motivate and energize you? If so, HPI is the place for you. Join a team that values integrity, flexibility, loyalty, compassion and dedication—we can’t wait to meet you.

What We Do

HPI is unique. A respected industry leader that’s been serving customers for over 44 years, we’re known for our innovation and adaptability. Our experience has given us our expertise, but our forward-thinking, entrepreneurial spirit has given us our strong reputation. As a third-party administrator, we offer a suite of health and benefit solutions to employers. By joining HPI, you’ll contribute to ideas that make a real difference for employers and employees nationwide. There isn’t a challenge we won’t accept and we’re looking for people who have a passion to take it on. Not just a job—a mission.

Our commitment extends beyond our clients to our own employees. We foster a supportive and inclusive work environment where innovation thrives. By investing in our team’s growth and well-being, we ensure they are equipped to provide exceptional service.

Join Our Case Management Team

At HPI, our Case Managers play a vital role in guiding individuals and their families through the healthcare system. Rooted in the Case Management Society of America’s definition, our approach is a collaborative process focused on assessment, planning, facilitation, care coordination, evaluation and advocacy. Our goal is to meet the comprehensive health needs of our members while promoting patient safety, quality of care, and cost-effective outcomes.

Our Case Managers —nurses, social workers and other healthcare professionals — serve as trusted partners helping members understand their conditions, access resources, and navigate care confidence.

What You’ll Do

As an HPI Case Manager, you’ll be dedicated to helping members achieve the best possible health outcomes. You will not only support individuals and their families but also contribute to the success of employer groups and the healthcare system as a whole.

In This Role, You’ll Also

• Conduct utilization management using standardized clinical criteria
• Consult with Physician Reviewers and other experts to determine appropriateness of care
• Develop individualized case management plans and Identify quality of care issues
• Telephonically assess members to ensure safe transition to next level of care upon discharge
• Determine and document quantifiable outcomes, including avoidable and actual dollar savings
• Continually educate the patient/family to promote self-management and self-advocacy
• Research available community resources and alternative funding sources as appropriate
  
  

What You Bring

• An active professional licensure as a Registered Nurse (RN) in MA, ME or NH (required)
• 3+ years of clinical experience (required)
• Competency in Windows-based computers (required)
• 3+ years Discharge Planning and/or Case Management experience
• Familiarity with URAC standards, Department of Labor, state/federal regulations
  
  

Why choose us?

• We’re a people-first company and value giving back to our community. Ask us about our volunteer opportunities.
• Our space is a reflection of who we are—innovative, open and collaborative.
• We think feeling your best is an important factor in producing great work, so we embrace a “smart casual” dress code and work at ergonomic desks.
• Need to reenergize? When at our Westborough headquarters, take a break to chat in the onsite café, go for a walk on one of the beautiful trails in our office park, or get in a quick workout at one of the campus gyms.
  
  

Our Benefits Package

We care about you and believe the greatest gift you can give yourself, your family, and the world is a healthy you! We offer a comprehensive and competitive benefits package to help you lead a happy, healthy life, including:

Medical, Dental and Vision and Prescription Drug Coverage

• Fitness Reimbursement Benefit
• Employee Assistance Program
• Flexible Spending Account & Health Savings Account
• 401(k) and Quarterly Bonuses
• Generous Paid-Time Off & Volunteering Opportunities
• Educational Assistance & Professional Development Opportunities
  
  

So, think you want to join the HPI team? We hope to hear from you!

You can read more about us at hpitpa.com/about-us/careers/

EEO/AA/M/F/Vet/Disability Employer

Seniority level

• Seniority level

  Mid-Senior level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Health Care Provider

• Industries

  Insurance

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