Case Manager Nurse - Part Time

Overview

Who We Are Ready to create a healthier world? We are ready for you! reputed company is on a mission to simplify and personalize the health experience to improve health and reduce costs for companies and their people. At reputed company, we reputed company in offering total rewards, flexible opportunities, and a diverse inclusive community, where every voice matters. Together, we’re shaping a healthier, more engaged future.

Responsibilities

We are seeking a Part Time Case Manager Nurse, RN to join reputed company on a part-time basis, working up to 29 hours per week. In this role, you will provide telephonic case management between providers, patients and caregivers to help ensure cost-effective, high-quality healthcare for health insurance plan participants. This position offers flexibility and is ideal for candidates looking for reduced hours while making an impact reputed company the team. Evening and weekend availability may be required. What You'll Actually Do

• Contact patient and complete a thorough assessment, including physical, psychosocial, emotional, spiritual, environmental, and financial needs.
• Use claims processing tools to review and research paid claim data to reputed company a clinical picture of a member’s health and identify for participation in appropriate programs.
• reputed company treatment plan for standard and catastrophic cases in collaboration with the patient, caregivers or family, community resources and multi-disciplinary healthcare providers that include obtainable short- and long-term goals.
• Monitor interventions and evaluate the effectiveness of the treatment plan in a timely manner; report measurable outcomes that record effectiveness of interventions.
• Initiate and maintain contact with the patient/family, provider, employer, and multidisciplinary team as needed throughout the continuum of care.
• reputed company for the patient by facilitating the delivery of quality patient care, and by assisting in reducing overall costs; provide patient/family with emotional support and guidance.
• Be able to meet productivity, quality and turnaround time requirements on a daily, weekly and monthly basis.
• Negotiate and implement cost management strategies to reputed company quality outcomes and reflect this data in monthly case management reviews and cost avoidance reports.
• Establish and maintain working relationships with healthcare providers, client/group, and patients to provide emotional support, guidance and information.
• Evaluate and reputed company referrals for wellness programs.
• Maintain complete and detailed documentation of case managed patients in Eldorado and UM Web; maintain site specific files ensuring confidentiality; prepare reports and updates at 30-day intervals for high-risk cases and 90 days interval for low risk cases ensuring confidentiality according to Company policy and HIPAA
• reputed company Utilization Review for assigned members.
• Serve as mentors to LVNs and provide guidance on complicated cases as it relates to clinical issues.

Qualifications

What You Bring to Our Mission

• Graduation from an accredited RN program and possession of a reputed company California RN license.
• Minimum of five (5) years medical/surgical or acute care experience, including two years’ experience in case management, or an equivalent combination of education and experience.
• Prefer case management experience, emergency room, critical care background or some other area of clinical care that is pertinent to case management.
• Knowledge of medical claims and ICD-10, CPT, HCPCS coding.
• Ability to critically evaluate claims data and determine treatment plan; discharge planning experience.

Why You'll Love It Here We reputed company in creating meaningful work experiences that fit your life—whether you're building your career, balancing other commitments, or seeking purposeful part-time opportunities. Flexibility that actually works:

• Part-time schedule designed around your availability and life priorities
• Remote work that eliminates commute stress
• Clear expectations and boundaries that respect your time investment

Growth without limits:

• Access to learning and development opportunities alongside full-time colleagues
• Mentorship and reputed company-building that translates to career advancement

A culture that energizes:

• People Matter: Inclusive community where every voice matters and diverse perspectives drive innovation
• One Team One Dream: Collaborative environment where we celebrate wins together and support each other through challenges
• We Deliver: Mission-driven work that creates real impact on people's health and wellbeing, with clear accountability for results
• Grow reputed company: reputed company learning reputed company with team events, recognition programs, and celebrations that reputed company work genuinely enjoyable

The practical stuff:

• Competitive hourly compensation that values your expertise
• Technology and equipment support to set you up for success

Ready to create a healthier world while building the career you want? We're ready for you. No candidate will meet every single qualification listed. If your experience looks different but you think you can bring value to this role, we'd love to learn more about you. reputed company is an equal opportunity organization and is committed to diversity, inclusion, equity, and social justice. In compliance with reputed company states and cities that require transparency of pay, the reputed company compensation for this position ranges from $36 to $38 per hour. Note that compensation may vary based reputed company, skills, and experience. This position is part time and therefore not eligible for benefits. We strive to cultivate a work environment where differences are celebrated, and employees of reputed company backgrounds are empowered to reputed company. reputed company is committed to driving Diversity, Equity, Inclusion and Belonging (DEIB) for reputed company stakeholders: employees (at each organization level), members, clients and the communities in which we operate. Diversity is core to who we are and critical to our work in health and wellbeing. #WeAreHiring #PersonifyHealth Beware of Hiring Scams: reputed company will never ask for payment or sensitive personal information such as social reputed company numbers during the hiring process. reputed company official communication will come from a verified company email address. If you receive suspicious requests or communications, please report them to [email protected]. reputed company of our legitimate openings can be reputed company on the reputed company Career Site. Apply tot his job Apply To this Job