Senior Case Manager RN
New
J
JobgetherHealthcare
Based in United StatesFull-TimeSenior
Salary79,300 - 127,100 USD per year
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Job Details
- Experience
- At least 5 years of experience in a combination of clinical care, case management, utilization management, disease condition management, provider operations, and/or health insurance
- Required Skills
- Microsoft OfficeEHR
Requirements
- Minimum 5 years of experience in clinical care, case management, utilization management, disease condition management, provider operations, or health insurance.
- Current State RN license or current multi-state licensure through the enhanced Nurse Licensure Compact (eNLC).
- Obtain Certified Case Manager (CCM) certification within 36 months of hire.
- High School diploma or GED; a Bachelor’s degree in Nursing is preferred.
- Strong expertise in clinical assessment, care planning, healthcare systems, and case management principles.
- Proficiency with Microsoft Office applications, case management software, and electronic health records.
- Ability to work effectively in a remote environment while meeting documentation, compliance, and care coordination requirements.
- Available for less than 25% travel and occasional physical work-site requirements.
- Experience with specialty clinical areas such as Oncology, Transplant, Maternity, NICU, or Pediatrics is preferred.
- Advanced training or experience in cognitive behavioral therapy (CBT), motivational interviewing, or dialectical behavior therapy (DBT) is preferred.
- Certification in a relevant clinical specialty, such as OCN, CPN, CPON, CNN, CCTC, or CPHQ, is preferred.
Responsibilities
- Manage a caseload of members with complex health needs requiring advanced clinical knowledge and comprehensive case management.
- Conduct detailed assessments of members’ health status, individual needs, available resources, and care requirements.
- Develop individualized and complex care plans in collaboration with members, physicians, and other healthcare providers.
- Monitor member progress toward established goals and adjust care plans and interventions based on changing needs.
- Collaborate and communicate professionally with physicians, providers, colleagues, and other members of the healthcare team.
- Maintain accurate documentation and ensure activities comply with applicable processes, policies, regulatory requirements, accreditation standards, and privacy obligations.
- Provide guidance and mentorship to lower-level Case Managers and serve as a resource for clinical expertise and complex problem-solving.
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