RN Case Manager – Care Coordination & Outcomes

Health Plans, Inc.; United States; On-site; USD 65,000 - 90,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

401(k)

Job summary

Health Plans, Inc. is seeking a dedicated Case Manager to guide members and families through the healthcare system, coordinating care and advocating for safe, cost-effective outcomes.

You’ll collaborate with physicians, nurses and other professionals to assess, plan, implement and evaluate individualized care. The role emphasizes patient education, resource navigation and support across employer groups and members nationwide.

Qualifications

• Active RN licensure in a compact state or state of residency.
• Minimum 3 years of clinical experience.
• Proficiency with Windows-based computers.
• At least 3 years in discharge planning or case management.
• Familiarity with URAC standards and applicable regulations.

Responsibilities

• Consult with physicians and reviewers to determine appropriateness of care.
• Develop and monitor individualized case management plans.
• Telephonically assess members and coordinate transitions of care.
• Document outcomes and measure cost savings.
• Educate patients and families to promote self-management.
• Identify community resources and funding opportunities.

Skills

Clinical experience

Discharge planning

Case management

Education

RN licensure (compact state)

Tools

Windows-based computers

Job description

Health Plans, Inc. is seeking a dedicated Case Manager to guide members and families through the healthcare system, coordinating care and advocating for safe, cost-effective outcomes.

You’ll collaborate with physicians, nurses and other professionals to assess, plan, implement and evaluate individualized care. The role emphasizes patient education, resource navigation and support across employer groups and members nationwide.