Pennsylvania Licensed Nurse Case Manager

Job Summary

To support a growing healthcare initiative, the full-time Pennsylvania Licensed Nurse Case Manager will conduct comprehensive assessments, evaluate benefit plans, and collaborate with members to promote optimal health outcomes in a remote setting.

Key responsibilities:

• Conduct comprehensive assessments of referred members' needs and eligibility using clinical tools and data review
• Evaluate benefit plans and available programs to determine the appropriate approach for case resolution
• Utilize case management processes in compliance with regulatory standards and company policies

Required qualifications:

• Active unrestricted RN license in Pennsylvania or a Compact state
• Associate's Degree in Nursing; Bachelor's Degree preferred
• 3+ years of clinical practice experience in settings such as hospital, home health, or ambulatory care
• 3-5 years of experience in the healthcare and/or managed care industry
• Proficiency in computer skills, including navigating multiple systems