West Virginia Licensed RN Case Manager

Job Summary

To support care management initiatives, the full-time West Virginia Licensed RN Case Manager will conduct comprehensive assessments, coordinate services, and ensure compliance with regulatory standards while working remotely in the EST time zone.

Key responsibilities

• Conduct comprehensive assessments of referred members' needs and eligibility using clinical tools and data review
• Determine appropriate case resolution approaches by evaluating members' benefit plans and available services
• Utilize case management and quality management processes in compliance with regulatory and accreditation guidelines

Required qualifications

• Active, unrestricted RN license in West Virginia or a compact state RN license
• Associate's Degree in Nursing (ASN) required; Bachelor's Degree (BSN) preferred
• 3 years of clinical practice experience in settings such as hospitals, home health, or ambulatory care
• 5 years of experience in the healthcare and/or managed care industry
• 3 years of case management experience