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 through various channels to foster trust and support their chronic/complex health care needs. You'll create and manage individualized care plans ensuring optimal health goals are met. Collaborate with members, families, providers, and community resources to coordinate care.

About you: You are a dedicated, caring professional motivated to provide ongoing support and education to members. You thrive in fast-paced environments excelling in time management, prioritization, and multi-tasking. Resourceful, collaborative, and adaptable with strong influencing skills are essential. Proficiency in utilizing and troubleshooting Microsoft Office (Outlook, Excel, Teams, etc.) is required.

Candidates located in Iowa or South Dakota are preferred. Top candidates possess prior health plan experience and diverse clinical background. Must obtain Certified Case Manager (CCM) certification within 24 months of hire and maintain it throughout employment.

This role is remote eligible. Candidates must provide high-speed internet at their work location.

Preferred Qualifications:

• Certified Case Manager (CCM)
• Care navigation/care coordination experience

Required Qualifications:

• Completion of an accredited nursing program
• Active and unrestricted RN License in Iowa or South Dakota (individual must be licensed in the state of residence)
• Certified Case Manager (CCM); obtain within 24 months of hire
• 4+ years of diverse clinical experience (acute care, outpatient, home health, etc.) reflecting 4+ years of direct clinical care to the consumer
• Experience in utilization management or health insurance setting is beneficial
• Strong verbal communication skills, influencing action, and facilitating crucial conversations with members, physicians, and care facilities
• Maintains courtesy and professionalism with all stakeholders
• Strong written communication skills, accurate documentation in case management platform adhering to guidelines and processes
• Commitment to service excellence and member advocacy
• Resourceful self-starter with a strong understanding of resources, processes, and guidelines; able to make independent decisions
• Able to organize and manage multiple priorities in a dynamic work environment
• Commitment to timeliness, follow-up, accuracy, and attention to detail
• Flexible and adaptable to change
• Strong technical acumen; learn new systems quickly (Microsoft Office, clinical documentation platforms, etc.)
• Knowledge of standards and regulations (URAC, NCQA, HIPAA, PHI confidentiality)

What you will do as a Case Management Nurse I:

1. Utilize critical thinking to identify high-risk conditions, proactively anticipate member needs, and navigate healthcare system resources.
2. Discuss care needs, support members, and develop effective care plans.
3. Identify care barriers and gaps, create unique plans ensuring communication, appropriate care, and avoid duplication. Provide education to achieve health goals.
4. Partner with members, families, providers, and community resources to coordinate care and services.
5. Engage members as participants in care planning, educate them on accountabilities and outcomes, advise on benefits, and discuss their impact on medical status and total cost of care.
6. Stay informed about evolving research/resources to improve member health and continue collaborations with clinical/non-clinical stakeholders.
7. Facilitate referrals, and support optimal service and member needs.
8. Accurately document activities in relevant technology tools, follow guidelines, and comply with regulations.
9. Be flexible to work weekends and/or holidays when needed.

What is the last date for applying to the job?

Which countries are accepted for this remote job?