RN Case Manager: Elevate Patient Care & Care Coordination

Sioux Center Health; Sioux Falls (SD); On-site; USD 43,000 - 63,000; Full time

Benefits offered by this job

PTO from day 1

Employer retirement match (5%)

Career development and mentorship

Job summary

Avera Health Plans is hiring an RN Case Manager to identify members who would benefit from complex and chronic condition care management and to develop and facilitate their plans of care. You will collaborate with physicians, population health staff, and care teams to improve outcomes.

The role requires knowledge of NCQA standards across commercial, marketplace, and self-funded plans, coordinating with hospitals, clinics, and stakeholders to deliver high-quality, cost-effective care and smooth

Qualifications

• Active RN license in state of practice
• CCM certification within 3 years or
• CMCN certification within 3 years
• 4-6 years nursing experience in acute care setting

Responsibilities

• Identify cases qualifying for complex/chronic condition management and/or service coordination from data sources.
• Create and execute care plans to meet individualized health goals per NCQA standards.
• Perform utilization management activities including preauthorizations and reviews for medical necessity.

Skills

RN license

Case management

Utilization management

Communication

Education

Registered Nurse (RN)

CCM certification

CMCN certification

Job description

Avera Health Plans is hiring an RN Case Manager to identify members who would benefit from complex and chronic condition care management and to develop and facilitate their plans of care. You will collaborate with physicians, population health staff, and care teams to improve outcomes.

The role requires knowledge of NCQA standards across commercial, marketplace, and self-funded plans, coordinating with hospitals, clinics, and stakeholders to deliver high-quality, cost-effective care and smooth