Required Education:• High School Diploma or EquivalentRequired License/Certification:• Unrestricted active RN Compact licensePreferred License/Certification:• Case Management Certification (CCM)Required Qualifications/Skills/Experience:• 3 years of clinical practice experience, such as hospital, home health, or ambulatory care• Case management experience• Healthcare and/or managed care industry experience• Previous experience working in a remote position• Proficiency with computer skills, including navigating multiple systems and keyboarding• Effective verbal and written communication skills• Ability to multitask, prioritize, and adapt effectively to a fast-paced, changing environment• Ability to work independently in a remote environment• Private, separate office space free from distractions due to HIPAA compliance• Ability to sit for extended periods while talking on the telephone and working on a computerRegistered Nurse (RN) Case Manager – Remote Overview:• The Registered Nurse (RN) Case Manager – Remote utilizes a collaborative process of assessment, planning, facilitation, and advocacy to identify options and services that meet an individual's benefit plan and/or healthcare needs• Through effective communication and the use of available resources, the Case Manager works to promote optimal, cost-effective outcomes• The role requires an RN with an unrestricted active Compact license and involves comprehensive assessment of referred members' needs and eligibility• Using clinical tools and information/data review, the Case Manager determines appropriate approaches for case resolution and evaluates available benefits, internal programs, and external services• The position requires the application and interpretation of applicable criteria, guidelines, standardized case management plans, policies, procedures, and regulatory standards to ensure appropriate administration of benefits• The Case Manager also utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and proceduresJob Duties• Conduct comprehensive assessments of referred members' needs and eligibility using clinical tools and information/data review• Determine appropriate approaches for case resolution and meeting member needs• Evaluate member benefit plans and available internal and external programs and services• Apply and interpret applicable criteria, guidelines, policies, procedures, and regulatory standards• Utilize standardized case management plans to support appropriate administration of benefits• Utilize case management and quality management processes in accordance with regulatory and accreditation guidelines• Advocate for options and services that support individual healthcare and benefit needs• Communicate effectively with members and available resources to promote optimal, cost-effective outcomes**Only those lawfully authorized to work in the designated country associated with the position will be considered.** **Please note that all Position start dates and duration are estimates and may be reduced or lengthened based upon a client’s business needs and requirements.**