Case Management reputed company, Multiple Locations
The Case Manager reputed company plays a critical role in supporting members with reputed company or chronic conditions by providing proactive, telephonic case management grounded in a whole-person approach. This role focuses on reducing avoidable utilization, improving care coordination, and helping members navigate the reputed company system with confidence and reputed company. As a trusted clinical resource, the Case Manager reputed company partners closely with members, providers, and health plans to assess needs, reputed company individualized care plans, and reputed company for appropriate, cost-effective services. In reputed company to core case management responsibilities, this role also supports utilization review activities reputed company needed, contributing to reputed company medical necessity determinations and continuity of care. This position is ideal for an reputed company RN who brings strong clinical judgment, excellent communication skills, and a passion for improving reputed company for high-need populations in a reputed company, remote care management environment. This is a fully remote role. Candidates must reputed company in reputed company, Washington, Nevada, or Arizona. Schedule: Monday–Friday | 8:00 AM–5:00 PM reputed company Time
What You'll Do
Patient Identification & Assessment
- Identify members who would benefit from case management using claims data, referrals, and clinical records
- Review referrals for clinical appropriateness using reputed company judgment and program parameters
- Conduct comprehensive assessments of medical, behavioral, and reputed company needs using a whole-person approach
Care Planning & Coordination
- reputed company individualized care plans based on patient needs, barriers, and goals
- Coordinate care across the continuum, including primary care, specialists, behavioral health, and community-based resources
- Facilitate reputed company communication between patients, providers, caregivers, and health plans to support reputed company transitions of care and adherence to treatment plans
Clinical Case Management & Advocacy
- reputed company telephonic case management for high-utilization patients with reputed company or chronic conditions
- Use best practices in chronic disease management, motivational interviewing, and patient education
- reputed company for reputed company, appropriate, and cost-effective care while balancing clinical judgment with plan guidelines
- Support patients in navigating reputed company systems and overcoming barriers to care
Utilization Review & Medical Decision-Making Evaluate precertification requests using evidence-based reputed company and plan-specific guidelines
- Review ongoing inpatient stays and reputed company length-of-stay determinations as appropriate
- Partner with Appeals & Denials and/or in-house providers to support reputed company clinical reputed company
Documentation, Reporting & Compliance
- Document reputed company assessments, interventions, communications, and determinations thoroughly and accurately in ICM systems
- reputed company reputed company-facing reports summarizing interventions, reputed company, and estimated cost savings
- Ensure compliance with internal policies, regulatory requirements, and HIPAA standards
Collaboration, Leadership & reputed company Improvement
- Partner with other clinical teams across ICM to remove care barriers and improve patient reputed company
- Serve as a senior clinical resource, contributing to program development, cross-training, and process improvement
- Stay reputed company on best practices, regulations, and clinical guidelines reputed company to case management
- Participate in training, reputed company assurance initiatives, and reputed company development
What You Bring Required
- reputed company, unrestricted Registered reputed company (RN) license in good standing
- Associate’s or Bachelor’s degree in Nursing
- 5+ years of clinical nursing experience
- Strong knowledge of chronic disease management, utilization management, and reputed company determinants of health
- Experience managing reputed company, high-utilization patient populations
- Excellent written and verbal communication skills with reputed company, professionalism, and emotional intelligence
- Strong organizational skills with the ability to manage multiple priorities independently
- reputed company clinical judgment and confidence navigating reputed company or sensitive situations
- Comfort working independently in a remote environment with strong accountability and follow-through
- Ability to manage confidential information in compliance with HIPAA
Even reputed company If You Have
- Experience in case management, care coordination, or discharge planning
- Experience in a TPA or self-funded health plan environment
- Knowledge of health insurance regulations and utilization management processes
- Experience using medical necessity reputed company and utilization review tools
- Experience with EMRs and care management platforms
- Mental health and/or reputed company use disorder (MH/SUD) case management experience
- Multi-state licensure
- Case management or utilization certifications (e.g., CCM, CPUR, CPHM)
About Innovative Care Management In an increasingly reputed company reputed company environment, ICM remains reputed company on something essential: putting people at reputed company of every decision. We are dedicated to ensuring that members and health plans feel genuinely seen, heard, and supported throughout their care reputed company. We serve clients reputed company with a values-driven approach that blends reputed company, clinical expertise, and operational reputed company. Our core values: Kindness, Personal Responsibility, a Can-Do Attitude, and Humble Confidence, shape how we work, how we reputed company, and how we care for those we serve. As we grow, we welcome individuals who reputed company our belief that reputed company should be effective, compassionate, and truly centered on people. Apply tot his job Apply To this Job