Nurse Care Manager

Employment Type: Full-Time Location Type: Remote

Position Overview

We are seeking passionate Nurse Care Managers to join our Care and Case Management team. In this telephonic role, you will holistically support members through their healthcare journey, ensuring their needs are met with industry-leading interventions. You will report to the Manager, Care and Case Management and will guide members through complex medical and behavioral health situations. This role requires partnering with a diverse clinical team, including healthcare professionals, care coordinators, and records specialists, to deliver integrated remote care creatively.

This position specifically focuses on members with behavioral health and substance abuse or substance abuse disorder needs, requiring experience with complex psychiatric and substance abuse disorders. The ideal candidate enjoys phone-based communication, actively listens to member needs, answers questions, and serves as an advocate. You will excel at creating cohesive care plans and possess the clinical skills to guide members and navigate available benefits and resources. Nurse Care Managers will support members through complex care management, disease management, and acute case management, ensuring they receive longitudinal care that results in excellent health outcomes.

#LI-Remote

Responsibilities

• Deliver coordinated, patient-centered virtual Care Management by telephone or video that improves members' health outcomes.
• Create impactful care plans collaboratively with members and our diverse care team, and help members achieve their goals.
• Assist members in navigating complex medical conditions, treatment pathways, benefits, and the healthcare system.
• Partner with members' local providers to ensure coordinated care.
• Provide compassionate, longitudinal follow-up care, building supportive relationships.
• Assist throughout acute healthcare episodes, such as hospitalizations and rehabilitation stays, providing coordinated Case Management to support the member and their family.
• Coordinate necessary resources that holistically address members' problems, whether clinical or social.

Qualifications

• Bachelor of Science in Nursing (BSN).
• Current CCM required.
• 5+ years of experience in nursing.
• 2+ years of experience in care, case, and disease management, preferably in a health plan, health navigator, or third-party administrator (TPA) environment.
• 2+ years of experience working in Behavioral Health and/or substance use field.
• Must reside in a compact NLC state.
• Active Compact RN license in good standing with the nursing board of their state.
• Active California Nursing License preferred.
• Willingness to become (and maintain) licensure in multiple states.
• Availability to work until 9-6 PM Local Time.
• Comfortable discussing multiple medical conditions and experience with populations across various age ranges.
• Spanish speaking is desirable.
• Experience working remotely, with strong competence and ability to use multiple computer/medical record systems.
• Empathy is crucial, as we work with patients and families during challenging times. You must practice empathy and reassure patients that we are available to help.
• Ability to meet volume goals without sacrificing quality in a fast-growing, busy company.
• Strict adherence to security and HIPAA regulations to protect patients' medical information.
• Must be pleasant, responsive, and willing to work with and learn from the team.
• Critical ability to gather clinical history, answer patient-level questions, and summarize findings due to significant phone time with patients, families, and colleagues.
• Efficiency in writing medical information in easy-to-understand, patient-centric language.

Physical/Cognitive Requirements

• Prompt and regular attendance at assigned work location.
• Capability to remain seated in a stationary position for prolonged periods.
• Eye-hand coordination and manual dexterity to operate keyboard.