RN Case Manager
Primary responsibilities include daily management and support of case management strategies for care coordination for a group of members associated with a Medicare Advantage plan. Patient visits are performed in person and/or via telephone to ensure proper nursing care. The role involves interviewing or corresponding with physicians to correct errors or omissions and investigate questionable claims. The RN collaborates with health care team members to assess, plan, implement, and evaluate patient care plans.
The position requires a self‑starter and team player who can manage multiple priorities, work with minimal supervision, and demonstrate excellent communication and presentation skills. Ability to adapt quickly to change and collaborate with multiple teams is essential.
Benefits
Annual performance wage increases
401(k) retirement plan with a company match
Medical, dental and vision insurance
$50,000 basic life insurance paid by the company
Paid time off
UKG Wallet – access your pay faster
Holiday pay
Telehealth through 98point6 – free to all employees
Continuing Education opportunities
Career advancement opportunities
Qualifications / Requirements
Minimum of 2 years of experience in clinical nursing or rehabilitation for the geriatric population
2 years of managed care experience required
Minimum of 3–5 years’ experience doing case management in a managed care environment, preferably with a managed care organization or like facility
Essential Functions
Complete health risk assessments for members as assigned
Initiate, update and/or revise care plans as needed
Maintain a case load of patients as assigned
Evaluate, coordinate, and plan patient care in collaboration with an interdisciplinary health team; reassess and revise plans of care in collaboration with other team members
Provide patient and family education based on identified learning needs utilizing available teaching resources
Coordinate outpatient discharge planning based on patient needs, clinical circumstances and benefit coverage
Participate in all managed‑care related audits; generate, maintain, and track periodic and annual reports/documents via MS Office and email to support the care coordination program
Perform improvement projects involving development of monitoring/collection tools, review of medical records, data entry, analysis, and preparation of audit findings and reports
Participate in patient care conferences, committee meetings, staff development and educational programs to increase or maintain professional competency
Correctly apply medical management criteria
Research clinical questions from employers, members and payers as required
Educate members on health access options
Respond, manage, and resolve day‑to‑day problems presented in care coordination and communicate effectively with the facility/home
Other duties as assigned
Education
Graduate of an accredited RN program
Bachelor’s degree preferred
Licensure / Certifications
Current license to practice as a registered nurse in the assigned state