01 USAble Mutual Insurance Company is hiring an RN Case Manager to play a critical role in optimizing patient care and resource utilization. You will be responsible for assessing, planning, implementing, coordinating, monitoring, and evaluating comprehensive care plans to meet individual health needs, focusing on quality patient outcomes and cost-effective healthcare delivery.
What You'll Do
- Assess, plan, implement, coordinate, monitor, and evaluate options and services required to meet an individual’s health needs through the use of plan benefits and community resources.
- Practice nursing within the scope of licensure and adhere to policies, procedures, regulations, and URAC standards, making decisions based on facts and evidence.
- Provide specialized education and knowledge on disease-specific conditions as needed.
- Remain current with up-to-date medical and surgical procedures, healthcare services, drugs, and trends in health care delivery.
- Serve as a liaison facilitating a collaborative process with patients, families, physicians, and other providers to promote quality of care and cost effectiveness.
- Work proactively with referrals to identify appropriate candidates for case management, explain services, and maintain a minimum patient caseload.
- Perform other duties as assigned.
What We're Looking For
- Registered Nurse (RN) with a current active state license in good standing where job duties are performed.
- Case management certification required. If not obtained prior to hire, must obtain a URAC-recognized certification within three (3) years. Acceptable certifications: CCM, ACM, or RN-BC.
- Minimum of four (4) years of clinical practice experience in case management, home health, critical care, medical/surgical, discharge planning, concurrent review, or obstetric/neonatal care.
Nice to Have
- Bachelor's degree in Nursing.
Technical Stack
- Affinite CM, Affinite UM, CCI Edits
- Customer Relationship Management (CRM), Customer Service Workstation
- Five9
- Microsoft Excel, Microsoft Office, Microsoft Outlook, Microsoft PowerPoint
Work Mode
This position operates in a hybrid work mode.
01 USAble Mutual Insurance Company is an equal opportunity employer.
