Full-Time Case Management Nurse I (Remote)

Use Your Strengths as a Case Management Nurse I at Wellmark!

About the role: As a Case Management Nurse I, you will serve as a key advisor actively engaging with members to foster a caring and trusting connection. Support their chronic and/or complex health care needs and concerns. Create and manage unique, individualized care plans ensuring the best possible health care goals and complex health needs are met. Partner with members, families, healthcare providers, and community resources to coordinate and facilitate care and services.

About you: You are a dedicated, caring healthcare professional motivated by providing personalized support and education. Thrive in a fast-paced environment. Strong time management, prioritization, and multitasking skills. Resourceful, collaborative, adaptable, and able to influence. Strong technology skills, experience in Microsoft Office products (Outlook, Excel, Teams, etc.) is a must. Candidates located in Iowa or South Dakota preferred. Prior health plan experience and diverse clinical background a plus. Obtain Certified Case Manager (CCM) certification within 24 months from hire date.

Required Qualifications:

• Completion of an accredited nursing program.
• Active and unrestricted RN License in Iowa or South Dakota. Licensed in state of residence.
• Certified Case Manager (CCM) certification (within 24 months of hire).
• 4+ years of diverse clinical experience (e.g., acute care, outpatient, home health, etc.) reflecting 4+ years of direct clinical care to consumers.
• Experience in utilization management or health insurance setting beneficial.
• Strong verbal and written communication skills.
• Commitment to service excellence, member advocacy, and critical thinking/problem-solving to anticipate needs.
• Resourceful self-starter with understanding of resources, processes, and guidelines.
• Ability to make independent decisions under ambiguity and manage multiple priorities.
• Strong technical acumen learning new systems quickly (e.g., Microsoft Office, clinical documentation platforms).
• Knowledge of standards and regulations (e.g., URAC, NCQA, HIPAA, PHI confidentiality).

What you will do as a Case Management Nurse I:

1. Utilize critical thinking to recognize high-risk/complex conditions requiring support and proactively anticipate member needs.
2. Discuss care needs and develop individualized care plans to ensure appropriate care and avoid duplication of services.
3. Proactively identify barriers and gaps in care and educate members on benefits/services.
4. Partner with members, families, providers and community resources to facilitate care and services.
5. Engage members in their care plans and advise on benefits for optimal health and cost-effectiveness.
6. Collaborate with internal/external stakeholders to improve member health.
7. Document care activities accurately, consistently, and timely following guidelines and policies.
8. Comply with regulatory, accreditation, and internal guidelines.
9. Other duties as assigned. (Must be flexible and able to work weekend/holiday hours as needed)

Remote Eligible:

• Flexible work from anywhere

Equal Opportunity Employer

What is the last date for applying to the job?

Which countries are accepted for this remote job?