Case Management Nurse RN

Job Summary

To support members facing serious diagnoses, the full-time Case Management Nurse RN will manage cases by phone, conduct comprehensive biopsychosocial assessments, and build individualized care plans while ensuring compliance with industry standards.

Key responsibilities

• Manage cases by leading short- and long-term care in accordance with company guidelines and industry criteria
• Conduct comprehensive assessments to evaluate physical, emotional, and financial factors impacting care decisions
• Develop and refine individualized treatment plans with measurable goals, while maintaining communication with all stakeholders

Required qualifications

• Graduate of an accredited nursing program
• Current RN license required based on business need
• 3 years of medical/surgical or acute care experience
• Working knowledge of NCQA, URAC, CMSA, and CMS standards
• Proficiency in Microsoft Office applications and basic computer literacy