Registered Nurse Care Manager

Job Summary

To support the health plan's medical management team, the full-time Registered Nurse Care Manager will identify and connect high-risk members to appropriate resources, manage self-referrals, and ensure compliance with accreditation standards, all while working remotely.

Key responsibilities

• Manage and triage member self-referrals to care management programs
• Perform utilization management reviews according to established clinical guidelines
• Identify barriers to quality of life for members and connect them with in-network providers and community resources

Required qualifications

• Current Registered Nurse license issued by the state or multi-state Registered Nurse license through the enhanced Nurse Licensure Compact (eNLC)
• Three years of healthcare clinical experience
• Experience managing Medicare and/or Medicaid populations is preferred
• Bachelor's Degree in Nursing or Associate of Science in Nursing Degree (ASN), or currently enrolled in a BSN program with completion within three years of hire
• Two years of Care Management experience is preferred