RN Case Manager

$83,200 - $83,200/Yr

CareNational Healthcare Services - Toledo, OH

Full-time - Mid Level

Remote - Toledo, OH

Administrative and Support Services

About the position

The Remote Registered Nurse (RN) - Case Manager is responsible for independently managing complex healthcare cases through various communication methods such as phone, email, and video conferencing. The role involves assessing patient needs, educating members about treatment options, coordinating services with community resources, and maintaining documentation in compliance with company and regulatory guidelines.

Responsibilities

• Independently manage complex healthcare cases via phone, email, and video conferencing.
• Verify eligibility, benefits, enrollment history, clinical history, and demographics.
• Assess patient needs by gathering information from members, families, providers, and other stakeholders.
• Educate members and assist them in removing barriers and exploring treatment options.
• Facilitate and implement interventions based on agreed-upon care treatment plans developed collaboratively with the healthcare team.
• Coordinate services with community resources and support groups for members.
• Maintain appropriate documentation within company and regulatory guidelines, policies, and practices.
• Perform other duties as assigned.

Requirements

• Valid RN license in Ohio or Compact RN license required.
• Bachelor's Degree preferred.
• 3 years of experience as a Registered Nurse with clinical and case management experience, preferably in the health insurance industry.
• Experience with MCO/Health Plan is required.
• Case Management and Home health care experience is a plus.
• Certified Case Manager (CCM) or other industry-recognized certification preferred (required within 3 years of hire).
• Certification in Motivational Interviewing preferred.
• In-depth knowledge of health insurance benefits, health plans, and industry trends.
• Strong knowledge of behavioral change techniques and health coaching.
• Knowledge of HIPAA compliance and related regulations.
• Knowledge of disease continuums and community services available.
• Intermediate proficiency in navigating Windows and web-based systems, and basic Microsoft Office skills.

Nice-to-haves

• Multiple state licensure preferred and may be required.
• Experience in health coaching and motivational interviewing.

Benefits

• Competitive hourly pay of $40.00.
• Remote work opportunity.
• Flexible schedule with Monday to Friday shifts.