The Telephonic Nurse Case Manager II is responsible for performing care management within the scope of licensure for members with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum. Performs duties telephonically. This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. Hours are Monday - Friday 9:30am - 6:00pm EST with 2-4 late evening shifts per month 11:30am to 8pm EST. Multi-State Licensure is required as this position services members in different states. Responsibilities include ensuring member access to appropriate services, conducting assessments, implementing care plans, coordinating resources, monitoring and evaluating care plans, interfacing with Medical Directors and Physician Advisors, negotiating reimbursement rates, assisting with provider and claims issues, and contributing to policy development. Minimum requirements include a BA/BS in a health-related field or equivalent experience, current unrestricted RN license in applicable state(s), and multi-state licensure if servicing multiple states. Preferred qualifications include Case Manager certification, critical thinking skills, proficiency with Microsoft Office or similar software, and experience in acute care and telephonic case management with a Managed Care Company. The position offers a salary range of $76,944 to $120,912 for candidates working in person or virtually in Colorado and New York, along with a comprehensive benefits package.
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