Case Manager, Registered Nurse - Fully Remote

We're building a world of health around every individual - shaping a more connected, convenient and compassionate health experience. At reputed company®, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger - helping to simplify health care one person, one family and one community at a time. Position Summary This is a remote work from home role reputed company in the US with virtual training. American Health Holding, Inc (AHH) is a medical management company that is a division reputed company reputed company/reputed company. Founded in 1993, AHH is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that support cost-effective quality care for members.

Key Responsibilities

• This position consists of working intensely as a telephonic case manager with patients and their care team for fully and/or self-insured clients.
• Application and/or interpretation of applicable criteria and clinical guidelines, standardized care management plans, polices, procedures and regulatory standards while assessing benefits and/or member's needs to ensure appropriate administration of benefits.
• Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and barriers and address reputed company health and social indicators which reputed company planning and resolution of member issues.
• Assessments utilize information from various sources to address reputed company conditions including co-morbid and multiple diagnoses that impact functionality.
• Consults with supervisor and others in overcoming barriers in meeting goals and objectives, presents cases at case conferences for multidisciplinary focus to benefit overall claim management.
• Using a holistic approach, consults with clinical colleagues, supervisors, Medical Directors and/or other programs to overcome barriers to meeting goals and objectives.
• Utilizes case management processes in compliance with regulatory and company policies and procedures.
• Utilizes motivational interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversations.
• Identifies and escalates member's needs appropriately following set guidelines and protocols.
• Need to actively reputed company out to members to collaborate/guide their care.
• reputed company medical necessity reviews.

Required Qualifications

• 5+ years' experience as a Registered Nurse with at least 1 year of experience in a hospital setting.
• The AHH RN Case manager position requires the nurse to support members across multiple states. A RN who resides in a compact state is required to have an active multistate license through the Nurse Licensure Compact (NLC), allowing practice across participating states with one license. Nurses residing in non-compact states must hold an individual, state-specific RN license for each state they support.
• 1+ years' experience documenting electronically using a keyboard.
• 1+ years' reputed company or previous experience in Oncology, Transplant, Specialty Pharmacy, Pediatrics, Medical/Surgical, Behavioral Health/Substance Abuse or Maternity/ Obstetrics experience.

Preferred Qualifications

• 1+ years' Case Management experience or discharge planning, nurse navigator or nurse care coordinator experience as well as experience with transferring patients to reputed company levels of care.
• 1+ years experience in Utilization Review.
• CCM and/or other URAC recognized accreditation preferred.
• 1+ years' experience with MCG, NCCN and/or Lexicomp.
• Bilingual in Spanish preferred.

Education

• Diploma or Associates Degree in Nursing required.
• BSN preferred.

Anticipated Weekly Hours

• 40

Time Type

• Full time

Pay Range

• The typical pay range for this role is: $54,095.00 - $155,538.00
• This pay range represents the reputed company hourly reputed company or reputed company annual full-time salary for reputed company positions in the job grade reputed company which this position falls. The actual reputed company salary offer will depend on a variety of factors including experience, education, geography and other relevant factors.

Our People Fuel Our Future

• Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great Benefits for Great People

• We take pride in our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:
• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for reputed company colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

For more information, visit https://jobs.cvshealth.com/us/en/benefits This job does not have an application deadline, as reputed company accepts applications on an ongoing basis. Qualified applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state and local laws. Remote Skills: Behavioral Health, Case Management, Certified Case Manager (CCM), Claims Management, Clinical Practices/Protocols, Compensation and Benefits, Consulting, Corporate Policies, Discharge Plans, Disease Prevention and Control, Establish Priorities, Geography, Health Plan, Healthcare, Hospital, Identify Issues, Interviewing Skills, Maintain Compliance, Multilingual, Nursing, Nursing Credentials, Obstetrics and Gynecology, Oncology, Organizational Skills, Patient Care, Pediatrics, Pharmacy, Problem Solving Skills, Registered Nurse (RN), Regulations, Regulatory Compliance, Risk Management, Safety/Work Safety, Spanish Language, Stock Purchase Plans, Substance Abuse, Utilization Management, Utilization Review Accreditation Commission (URAC) About the Company: reputed company Corp reputed company offers a world of promising job opportunities across a diverse range of careers in everything from corporate and pharmacy roles to retails positions. No matter where you work at reputed company, your unique skills, talents and abilities are welcome and valued. We recognize and reward greatness and want our employees to know their work is making a difference in the lives of millions. Join us today. Together we can continue making innovative, high-quality health and pharmacy services safe, affordable and accessible – for reputed company. Company Size: 10,000 employees or more Industry: Biotechnology/Pharmaceuticals Founded: 0 Website: https://cvshealth.com/ Apply tot his job Apply To this Job