
10.000+ Mitarbeiter
🏥 Gesundheitswesen
⚕️ Krankenversicherung
🤝 B2B
Healthcare • Healthcare Insurance • B2B
null
🔥 vor 8 Stunden
🇺🇸 Vereinigte Staaten – Remote
⏰ Vollzeit
🟡 Mittelstufe
🟠 Senior
👔 Manager
🦅 H1B-Visum-Sponsor
👻 Geisterscore 10%
🗣️🇺🇸🇬🇧 Englisch erforderlich
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10.000+ Mitarbeiter
🏥 Gesundheitswesen
⚕️ Krankenversicherung
🤝 B2B
Healthcare • Healthcare Insurance • B2B
null
• Provide telephonic care management for members with complex and chronic care needs within the scope of licensure • Assess members and develop specific care management plans • Implement care plans by facilitating authorizations and referrals within the benefits structure or through extra-contractual arrangements • Coordinate internal and external resources to meet identified needs • Monitor and evaluate care plan effectiveness and modify plans as necessary • Ensure member access to services appropriate to their health needs • Interface with Medical Directors and Physician Advisors on care management treatment plans • Assist with provider, claims, or service-related problem solving • Assist with developing utilization and care management policies and procedures • Service members in different states
• Requires a BA/BS in a health-related field • 3 years of clinical experience; or any combination of education and experience, which would provide an equivalent background • Current, unrestricted RN license from the State of Georgia required • Multistate licensure is required if providing services in multiple states • Ability to talk and type at the same time • Certification as a Case Manager • Demonstrate critical thinking skills when interacting with members • Experience with Microsoft Office and/or ability to learn new computer programs/systems/software quickly • Ability to manage, review and respond to emails/instant messages in a timely fashion • Must reside in the State of Georgia • Must complete the online pre-employment skills assessment within 48 hours of receipt and meet the criteria • Monday–Friday availability, 11:00am–7:30pm, with one 8:30am–5:00pm EST shift per week
• Merit increases • Paid holidays • Paid Time Off • Incentive bonus programs • Medical benefits • Dental benefits • Vision benefits • Short-term disability benefits • Long-term disability benefits • 401(k) + match • Stock purchase plan • Life insurance • Wellness programs • Financial education resources • Virtual full-time work with flexibility and autonomy • Required in-person training sessions • Accommodation for qualifying candidates as required by law
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