Job Description
Role Description The Nurse Case Manager serves as a customer advocate, partnering with members, families, and providers to coordinate care and support navigation of the healthcare system. This role focuses on whole-person health, behavior change, and delivering high-quality, customer-centered outcomes aligned with Care Solutions cultural beliefs. • Partner with customers to develop, implement, and document individualized care plans. • Use motivational interviewing, behavior change strategies, and shared decision-making to support health goals. • Coordinate care with providers, caregivers, and internal clinical partners to support whole-person health. • Engage customers through telephonic, digital, and written communication channels. • Track and document activities, outcomes, and progress in medical management systems. • Follow standard operating procedures and meet defined case management performance measures. • Maintain clinical expertise through required training and continuing education. Qualifications • Active, unrestricted Registered Nurse (RN) license in a U.S. state or territory. • Minimum of two (2) years of full-time direct patient care experience as an RN. • Nursing degree from an accredited nursing program. • Ability to work an 8-hour shift between 9:00 a.m. and 9:00 p.m. EST, including evenings as business needs require. • Strong communication skills across telephonic and digital platforms. • Proficiency with Microsoft Word, Excel, Outlook, and clinical documentation systems. Requirements • Case management certification (URAC-recognized) obtained within four (4) years of hire. • Experience working in remote, telephonic, or digital care management environments. • Strong organizational skills with the ability to manage multiple priorities in a fast-paced setting. • Demonstrated ability to work effectively with culturally diverse populations. • Flexibility to support non-standard shifts or occasional on-site meetings or audits. • If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload. Benefits • Annual salary of 77,500 - 129,100 USD / yearly, depending on relevant factors, including experience and geographic location. • Eligibility to participate in an annual bonus plan. • Comprehensive range of health-related benefits including medical, vision, dental, and well-being and behavioral health programs. • 401(k) plan. • Company paid life insurance. • Tuition reimbursement. • A minimum of 18 days of paid time off per year and paid holidays.