Case Management Nurse I

Case Management Nurse I

Requirements

• Completion of an accredited nursing program.
• Active and unrestricted RN License in Iowa or South Dakota. Individual must be licensed in the state in which they reside.
• Certified Case Manager (CCM); must obtain within 24 months of hire.
• 4+ years of diverse clinical experience (e.g., acute care, outpatient, home health, etc.) that reflects 4+ years of direct clinical care to the consumer. Experience in utilization management or health insurance setting beneficial.
• Strong verbal communication skills; influences action and facilitates crucial conversations regarding care with members, physicians, and care facilities.
• Maintains courtesy and professionalism when engaging with members, internal and external stakeholders.
• Strong written communication skills, including accurate documentation of events within the case management platform; ensures quality and consistency by following guidelines and processes.
• Commitment to service excellence and member advocacy; uses critical thinking and problem-solving skills to anticipate member and provider needs.
• Resourceful self-starter who demonstrates strong understanding of resources, processes, and guidelines. Able to make independent decisions or recommendations under ambiguity.
• Ability to organize and manage multiple priorities in a dynamic work environment where quality and/or production goals are measured. Commitment to timeliness, follow up, accuracy and attention to detail. Flexible and adapts to change.
• Strong technical acumen; learns new systems quickly – e.g., Microsoft Office, clinical documentation platforms, etc.
• Knowledge of standards and regulations – e.g., URAC, NCQA, HIPAA, PHI confidentiality.

Responsibilities

No responsibilities provided.

Preferred Qualifications

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