Case Manager, Registered Nurse – NJ, PA or WV

Job Description: • Facilitate the delivery of appropriate benefits and/or healthcare information which determines eligibility for benefits while promoting wellness activities. • Develops, implements, and supports Health Strategies, tactics, policies and programs that ensure the delivery of benefits and to establish overall member wellness and successful and timely return to work. • Acts as a liaison with member/client/family, employer, provider(s), insurance companies, and healthcare personnel as appropriate. • Implements and coordinates all case management activities relating to catastrophic cases and chronically ill members/clients across the continuum of care that can include consultant referrals, home care visits, the use of community resources, and alternative levels of care. • Interacts with members/clients telephonically • Assesses and analyzes injured, acute, or chronically ill members/clients medical and/or vocational status; develops a plan of care to facilitate the member/client’s appropriate condition management to optimize wellness and medical outcomes, aid timely return to work or optimal functioning, and determination of eligibility for benefits as appropriate. • Communicates with member/client and other stakeholders as appropriate (e.g., medical providers, attorneys, employers and insurance carriers) telephonically or in person. • Prepares all required documentation of case work activities as appropriate. • Interacts and consults with internal multidisciplinary team as indicated to help member/client maximize best health outcomes. • May make outreach to treating physician or specialists concerning course of care and treatment as appropriate. • Provides educational and prevention information for best medical outcomes. Requirements: • 3+ years clinical practical experience preference: (diabetes, CHF, CKD, post-acute care, hospice, palliative care, cardiac) with Medicare members. • Ability to occasionally travel within a designated geographic area for in-person case management activities as directed by Leadership and/or as business needs arise. • Reliable transportation required. • Mileage is reimbursed per our company expense reimbursement policy • 1+ year(s) of experience with Microsoft Office applications (MS Word, Excel, Outlook and PowerPoint) • Active Compact License in NJ, PA or WV preferred • Minimum 2+ years CM, discharge planning and/or home health care coordination experience • Certified Case Manager is preferred. • Excellent analytical and problem-solving skills • Effective communications, organizational, and interpersonal skills. • Efficient and Effective computer skills including navigating multiple systems and keyboarding Benefits: • Affordable medical plan options • 401(k) plan (including matching company contributions) • Employee stock purchase plan • No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs • Confidential counseling and financial coaching • Paid time off • Flexible work schedules • Family leave • Dependent care resources • Colleague assistance programs • Tuition assistance • Retiree medical access Apply Now Apply Now