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Job Overview

Bilingual Spanish-English Nurse Case Manager I/II/Sr

Location:  Any US location

 

This position requires a Berlitz language test. This test is free of charge and is conducted via the phone with a translator.  Candidates who are considered will be contacted via email with instructions. In order to move forward in the process, you must complete the test and meet the criteria.

  

Responsible for performing care management within the scope of licensure for members with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum. Primary duties may include, but are not limited to: Ensures member access to services appropriate to their health needs. Conducts assessments to identify individual needs and a specific care management plan to address objectives and goals as identified during assessment. Implements care plan by facilitating authorizations/referrals as appropriate within benefits structure or through extra-contractual arrangements. Coordinates internal and external resources to meet identified needs. Monitors and evaluates effectiveness of the care management plan and modifies as necessary. Interfaces with Medical Directors and Physician Advisors on the development of care management treatment plans. Negotiates rates of reimbursement, as applicable. Assists in problem solving with providers, claims or service issues.

 

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 applicable state(s) required. Multi-state licensure is required if this individual is providing services in multiple states. Certification as a Case Manager is preferred. Must be bilingual and proficient in both Spanish and English.

 

For URAC accredited areas the following applies: Requires a BA/BS; 3 years of clinical care experience; or any combination of education and experience, which would provide an equivalent background. Current and active RN license required in applicable state(s). Multi-state licensure is required if this individual is providing services in multiple states. 5 years of experience, certification as a Case Manager from the approved list of certifications, and a BS in a health or human services related field preferred.