Case Manager - NLC

• Apply the core principles of case management, including assessment, planning, implementation, coordination, monitoring, and evaluation, to support patients throughout their care journey.
• Conduct comprehensive assessments of patients’ medical, social, psychological, and long-term needs using relevant health and social histories.
• Develop individualized plans of care based on clinical assessments, patient needs, provider recommendations, benefit-plan considerations, and cost-effectiveness factors.
• Continuously monitor and evaluate care plans, adjusting interventions as patient needs, clinical circumstances, or available resources change.
• Identify barriers that may prevent successful care outcomes and implement appropriate solutions, alternative services, or levels of care.
• Advocate for patients by identifying potential complications, understanding the physical and psychosocial impact of illness, and helping patients access appropriate services and resources.
• Establish and maintain effective working relationships with physicians, providers, payors, support staff, and other members of interdisciplinary care teams.
• Coordinate decisions, documentation, reimbursement, appeals, and other case-management processes while maintaining accurate and timely records.
• Evaluate the quality and cost effectiveness of services in collaboration with payors, providers, and other stakeholders, including negotiating cost discounts when appropriate.
• Identify and coordinate alternative care options such as rehabilitation facilities, home health services, community programs, assistive equipment, and other appropriate resources.
• Research and develop community support networks that can help patients achieve improved psychological, social, and physical outcomes.
• Clearly communicate available services, benefits, and resources to patients and assist them in accessing appropriate support.
• Apply relevant case-management principles, confidentiality requirements, liability considerations, disability legislation, and scope-of-practice standards.
• Analyze case outcomes, apply structured problem-solving techniques, and implement alternative approaches when appropriate.
• Maintain timely documentation of patient care plans and ensure compliance with applicable regulatory and privacy requirements.
• Participate in professional development, continuing education, training initiatives, and relevant organizational committees.
• Provide guidance and support to support staff as appropriate and contribute to orientation and training related to the Case Manager role.
• Perform all assignments professionally and independently while demonstrating accountability, collaboration, trust, and passion for patient care.

Requirements

• Active, current, unrestricted Registered Nurse (RN) license in a Nurse Licensure Compact (NLC) state.
• Bachelor’s degree in nursing or a related field is preferred.
• Case Management Certification (CCM) is required; candidates without the certification must obtain it within three years of employment.
• At least three years of clinical RN experience in a medical/surgical or ambulatory care setting.
• Clinical experience in behavioral health, transplant, neonatal care, oncology, or another relevant specialty is preferred.
• Previous managed-care experience is an advantage.
• Strong clinical knowledge of the healthcare and social-support needs of the populations served.
• Demonstrated ability to identify barriers to successful care management and develop practical solutions.
• Strong understanding of care coordination, alternative care models, community resources, and interdisciplinary collaboration.
• Excellent problem-solving, organization, prioritization, and time-management skills.
• Strong written, verbal, and interpersonal communication skills, with the ability to work effectively with patients, physicians, providers, payors, and other stakeholders.
• Ability to work independently while exercising sound clinical judgment and maintaining accurate, timely documentation.
• Flexibility to manage changing assignments, schedules, patient needs, and priorities.
• Knowledge of assistive and adaptive equipment and applicable disability-related legislation, including the Americans with Disabilities Act.
• Ability to practice appropriately within the scope of a multi-state RN license.
• Demonstrated commitment to professional conduct, confidentiality, quality improvement, and patient advocacy.
• Ability to work in alignment with core values centered on passion, teamwork, accountability, and trust.
• Employment visa or immigration sponsorship is not available for this position.

Benefits

• $35.50–$38.00 per hour hiring compensation range.
• Compensation may vary based on skills, education, location, experience, and other job-related factors.
• Potential eligibility for a scorecard-based incentive.
• Comprehensive employee benefits package.
• Medical and healthcare benefits.
• Retirement benefits.
• Generous paid time off.
• Paid holidays.
• Remote work environment.
• Opportunities for professional development and continuing education.
• Supportive, collaborative culture focused on growth, innovation, and teamwork.
• Opportunities to make a meaningful impact through patient advocacy and care coordination.
• Equal opportunity workplace with reasonable accommodations available for qualified applicants.