RN - Telephonic Case Manager

• Documentation & Quality Reporting
• Document assessments, outreach, care plans, and interventions accurately in the electronic health record (EHR)
• Ensure documentation meets organizational policies and regulatory and audit standards
• Identify and help close HEDIS care gaps and other quality performance measures
• Participate in quality improvement activities to strengthen care coordination outcomes

• Interdisciplinary Collaboration
• Collaborate with physicians, nurses, social workers, and other care team members to coordinate care
• Align services and resources across medical, behavioral health, and social needs
• Communicate member priorities, barriers, and care plan updates to the interdisciplinary team

• Program Development Support
• Contribute to the development and maintenance of policies, procedures, and workflows for case management programs
• Identify opportunities to streamline care coordination, improve member experience, reduce avoidable utilization, and advance value-based care goals
• Participate in continuous improvement initiatives aligned with organizational goals and quality performance

Qualifications

• and Education
• Active multistate Registered Nurse (RN) license required
• CCM certification preferred
• Minimum 2+ years of experience in care management, case management, or population health
• Experience supporting Medicaid populations or complex care environments preferred
• Knowledge of Long-Term Services and Supports (LTSS) programs
• Experience using electronic health record (EHR) systems
• Ability to manage complex caseloads in a remote work environment
• Strong communication and care coordination skills

EEO Statement

We are an Equal Opportunity Employer and are committed to fostering an inclusive and diverse workplace. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy, sexual orientation, gender identity or expression), national origin, age, disability, genetic information, veteran status, or any other protected characteristic in accordance with applicable federal, state, and local laws. We believe inclusion strengthens our organization and enhances our ability to serve members and communities nationwide. We are committed to providing reasonable accommodation for qualified individuals with disabilities throughout the recruitment and employment process.