This is a fully remote Clinical Care Manager position where you will use a proprietary software platform to optimize engagement with your patients. Nurses will work from home reviewing patient vitals, managing care plans, responding to alerts, and providing education. You will act as a liaison, coordinating care with physicians and helping patients develop healthy habits.

This job involves reviewing medical records for medical necessity, providing skilled nursing care, completing patient evaluations, and ensuring timely review of requests for post-acute services based on clinical guidelines. The Utilization Review Clinician will comply with standard operating procedures, departmental, and organizational policies, fostering relationships with healthcare providers to improve health outcomes.

The role involves performing concurrent reviews, determining member's overall health, reviewing the type of care being delivered, evaluating medical necessity, and contributing to discharge planning. It also includes evaluating inpatient services to validate the necessity and setting of care being delivered to the member.

As a Case Manager, you will offer telephonic case management for members experiencing severe or chronic health conditions. You will coordinate care and services and develop patient treatment plans for catastrophic cases. The role involves patient education, emotional support, and assistance with care coordination and requires an active RN license.

The Case Manager LVN/LPN will coordinate patient care over the phone between providers and caregivers to help ensure cost-effective, high-quality healthcare for health insurance plan participants. Manage cases on a short- and long-term basis over the phone and educate patients on treatment and services options.

Provide first-line medical assessment, triage, and assistance via telemedicine and direct coordination. Conduct pre-deployment screenings, travel health assessments, and repatriation planning. Review medical records and treatment plans to ensure appropriate and effective care. Manage complex medical cases, including emergency response coordination and medical evacuations.

Deliver coordinated, patient-centered virtual Care Management by telephone or messaging that improves members' health outcomes. You will specialize in guiding members through both routine and complex infertility and maternity clinical scenarios. Strong empathy and commitment to patient-centered care is needed.

Responsible for delivering coordinated, patient-centered virtual Care Management by telephone or messaging that improves members' health outcomes. You will create impactful care plans together with members and our diverse care team, and help members achieve their desired goals, navigating complex medical conditions, treatment pathways, benefits, and the healthcare system.