Remote Nurse Care Manager (Payer/Insurance Experience Required)
Base pay range: $38.00/hr - $43.00/hr
This telephonic role guides members through their healthcare journey with proactive engagement for high-risk and rising-risk individuals. You will partner with a multidisciplinary clinical team to deliver integrated remote care, focusing on discharge planning and care transitions. The ideal candidate enjoys phone-based engagement, active listening, and advocating for members while creating cohesive care plans and navigating available benefits and resources.
Schedule: CA Based/Licensed: Monday - Friday, 9:00 AM - 6:00 PM PST
Responsibilities
Engage in high-value Care Management outreach calls for Included Health members, focusing on clinically engaging high-risk and rising-risk members, fostering relationships and proactive health management.
Make proactive calls to members after hospital discharge is confirmed, conducting intake assessments when contacted.
Collaborate with hospital-based case managers to understand and support discharge needs and encourage engagement with the Care Management program.
Perform initial assessments including activities of daily living, cognitive function, social determinants of health (SDOH), health beliefs and behaviors, and life planning to develop holistic care strategies.
Deliver coordinated, patient-centered virtual Care Management by telephone and/or video to improve health outcomes.
Generate care plans collaboratively with members and the multidisciplinary care team to help members achieve health goals.
Coordinate resources to address clinical or social needs.
Qualifications
Bachelor of Science in Nursing (BSN)
Compact Nursing License with active California RN and Illinois licenses in good standing
5+ years of clinical nursing experience
2+ years in care management, case management, or disease management, preferably within a health plan, health navigator, or TPA environment
Remote care or case management experience
Comfort discussing a wide variety of medical conditions and experience with populations across all ages
Strong comfort with technology and proficiency with multiple electronic medical/health record systems
Compensation
$38/hr to $43/hr
Exact compensation may vary based on skills, experience, and education.
Benefits & Eligibility
Benefit packages start on the 31st day of employment and include medical, dental, and vision insurance, HSA, FSA, DCFSA options, and 401k with employer matching. Paid sick leave and/or other paid time off are provided as required by applicable law.