Nurse Care Manager, Adult

Position Overview

• Location Type: Remote
• Job Type: Full-Time
• Salary: Not Specified

We are seeking passionate Nurse Care Managers to join our Care and Case Management team. This role is ideal for individuals with experience working with a health plan, health navigator, or third-party administrator (TPA). As a telephonic Nurse Care Manager, you will guide members through complex medical and behavioral health situations, partnering with a diverse clinical team to deliver integrated remote care. You will be an advocate for members, creating cohesive care plans and utilizing your clinical skills to navigate benefits and resources. This role involves supporting members through complex care management, disease management, and acute case management to ensure longitudinal care and excellent health outcomes.

Responsibilities

• Deliver coordinated, patient-centered virtual Care Management via telephone or video to improve member health outcomes.
• Create impactful care plans collaboratively with members and the care team, helping 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 during acute healthcare episodes (e.g., hospitalizations, rehabilitation stays) by providing coordinated Case Management.
• Coordinate necessary resources to holistically address members' clinical or social problems.
• Strictly follow security and HIPAA regulations to protect patient medical information.
• Gather clinical history, answer patient-level questions, and summarize findings effectively.
• Write medical information in easy-to-understand, patient-centric language.

Requirements

• Bachelor of Science in Nursing (BSN).
• CCM Certification or eligibility.
• 5+ years of experience in nursing.
• 2+ years of experience in care management.
• Must reside in a compact NLC state.
• Active Compact RN license in good standing with the nursing board of their state.
• Willingness to become and maintain licensure in multiple states.
• Work 9 am - 6 pm (Preference for those based in MST/PST time zones).
• Comfortable discussing multiple medical conditions and experience with populations across age ranges.
• Spanish speaking is desirable.
• Experience working remotely.
• Strong competence and ability to use multiple computer/medical record systems.
• Empathy and the ability to reassure patients during challenging times.
• Ability to meet volume goals without sacrificing quality.
• Pleasant, responsive, and willing to work with and learn from the team.

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, computer, and other office-related equipment.
• Occasional exertion of about 20 lbs of force may be required (e.g., lifting a computer/laptop).
• Capability to work appropriately with leadership, employees, and members.