Case Manager, RN

🔥 0 minutes ago

🌪️ Oklahoma – Remote

🌪️ Oklahoma – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

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GlobalHealth, Inc.

WebsiteLinkedInAll Job Openings

51 - 200 employees

Founded 2003

🛡️ Insurance

🏥 Healthcare

⚕️ Healthcare Insurance

Insurance • Healthcare • Healthcare Insurance

GlobalHealth, Inc. is a health insurance company that offers Medicare Advantage (Part C) HMO plans, including Chronic Special Needs Plans (C-SNP) and Dual Special Needs Plans (D-SNP), primarily serving beneficiaries in Oklahoma. It provides Medicare and Medicaid-contracted benefit plans with prescription drug (Part D) coverage, supplemental benefits (dental, vision, hearing, OTC allowances), home support services, transportation, fitness benefits, and member/provider portals and tools for enrollment, claims, and care management. GlobalHealth focuses on serving retirees and dual-eligible or chronically ill populations through local agent support, provider networks, and compliance with Medicare quality standards.

📋 Description

• Conduct telephonic case management for complex, high-risk members, including needs identification and assessment, care planning and coordination, and outcome monitoring • Coordinate with providers to support holistic, healthy, beneficial outcomes • Maintain awareness of patient needs and condition changes through interdepartmental communication, network communication, and member outreach • Provide patient advocacy, support, quality-care assessment, and crisis intervention • Coordinate member services, including community resources, with other care-team members • Educate members and caregivers about conditions and self-management techniques • Initiate and participate in SNP MOC elements, including HRA completion, ICP creation, and ICT initiation • Complete transition-of-care activities, including post-discharge assessment, medication reconciliation/review, and ensuring follow-up-care access

🎯 Requirements

• High School or Equivalent education level • Active Registered Nurse license in the state of Oklahoma required • Active multi-state RN license preferred • Previous experience in managed care/utilization management preferred • Knowledge of current nursing processes, techniques, and established standards • Knowledge of disease management, medications, and community resources • Strong attention to detail and organizational, multitasking, and time-management skills • Ability to communicate clearly and effectively orally and in writing • Knowledge of Microsoft Word, Excel, and PowerPoint • Ability to work independently or as a team member • Reliable and secured internet connection • Ability to maintain confidentiality of business information and Protected Health Information in accordance with HIPAA and company policy • Ability to follow company privacy and security policies

🏖️ Benefits

• Remote work environment • No travel required