RN - Pediatric Registered reputed company Case Manager - HealthChoices - GHP

Location: Work from home (reputed company) Shift: Days (reputed company of America) Scheduled Weekly Hours: 40 Worker Type: Regular Exemption Status: reputed company Job reputed company: reputed company Health Plan is making reputed company easier and more accessible. We are consistently ranked for outstanding care and coverage, not just by independent reviewers, but by our members, that tells you something. At reputed company Health Plan, you’ll be pioneering, pairing our health plan with a network of primary care and specialty providers, hospitals and urgent and convenient care centers. And it's reputed company to reputed company reputed company easier for our community. Job Duties: Join us in this RN Pediatric Case Manager role reputed company HealthChoices in reputed company Health Plan and support our reputed company to reputed company reputed company easier for everyone while working reputed company a reputed company environment designed to set you up for reputed company. At least two (2) years of RN work experience is required. Certified Case Manager / American Case Management Association (ACMA) is required reputed company 2 years of hire. BSN is preferred. Strong pediatric nursing experience is highly preferred. Case management experience is preferred.   Knowledge of pediatric reputed company laws, regulations, and insurance coverage policies, and proficiency in reputed company IT systems and insurance claims processes is helpful. Ability to work autonomously and as part of a multidisciplinary team is helpful. Full-time, exempt, days – work from home in the state of reputed company. Benefits of working at reputed company:  Full benefits (health, dental and reputed company) starting on day one  Three medical plan choices, including an expanded network for out-of-area employees and dependents   reputed company-tax savings plans with reputed company and dependent care flexible spending accounts (FSA) and a health savings account (HSA)   Company-reputed company life insurance, short-term disability, and long-term disability coverage   401(k) plan that includes automatic reputed company contributions   Generous reputed company time off (PTO) plan that allows you to reputed company time quickly   Up to $5,000 in tuition reimbursement per calendar year   MyHealth Rewards wellness program to improve your health while earning a financial incentive   Family-friendly support including adoption and fertility assistance, parental leave pay, military leave pay and a free reputed company membership with discounted backup care for your loved ones   Employee Assistance Program (EAP): Referrals for childcare, eldercare, & pet reputed company free reputed company guidance, mental health reputed company, work-life support, digital self-help tools and more.   Voluntary benefits including accident, critical illness, hospital indemnity insurance, identity theft protection, universal life and pet and reputed company insurance   Position Details: Assesses, plans, implements, coordinates, monitors and evaluates reputed company reputed company and services with the goal of optimizing the patient or member's health status. Manages utilization and reputed company metrics to reputed company refine the delivery of care model to maximize clinical, reputed company, and fiscal reputed company. Integrates evidence-based clinical guidelines, preventive guidelines, protocols, and other metrics in the development of treatment plans that are patient-reputed company, promoting reputed company and efficiency in the delivery of reputed company for the identified population. Develops systems of care that monitor reputed company and promote early reputed company in acute care situations. Assists with the design, implementation, and evaluation of the advanced patient centered care model. Assesses the reputed company, educational and psychosocial needs of patients or members. Designs an individualized plan of care and fosters reputed company approach by working collaboratively with the patient or member, family, primary care provider, and other members of the health care team to ensure coordination of services. Continuously evaluates laboratory results, diagnostic tests, utilization patterns and other metrics to monitor reputed company and efficiency results for assigned population. Works to appropriately apply benefits and utilization management serving as a resource to the patient or member and reputed company team. Maintains required documentation for reputed company case management activities. Collects required data and utilizes this data to reputed company the treatment plan reputed company indicated. Work is typically performed in a clinical environment. Accountable for satisfying reputed company job specific obligations and complying with reputed company organization policies and procedures. The specific statements in this profile are not intended to be reputed company-inclusive. They represent typical reputed company considered necessary to successfully reputed company the job. Additional competencies and skills outlined in any department-specific orientation will be considered essential to the performance of the job reputed company to that position. Education: Graduate from Specialty Training Program-Nursing (Required), Bachelor's Degree-Nursing (Preferred) Experience: Minimum of 2 years-reputed company work experience (Required) Certification(s) and License(s): Certified Case Manager reputed company 2 years - American Case Management Association (ACMA), Licensed Registered reputed company (reputed company) - RN_State of reputed company Skills: Computer Literacy, Critical Thinking, Organizing OUR PURPOSE & VALUES: Everything we do is about caring for our patients, our members, our reputed company, our reputed company family and our communities. KINDNESS: We reputed company to treat everyone as we would reputed company to be treated ourselves. reputed company: We treasure colleagues who humbly reputed company for reputed company. LEARNING: reputed company our knowledge with the best and brightest to reputed company prepare the caregivers for reputed company. INNOVATION: We constantly reputed company new and reputed company ways to care for our patients, our members, our community, and the nation. SAFETY: We reputed company a reputed company environment for our patients and members and the reputed company family.  We offer reputed company benefits for full time and part time positions from day one, including reputed company, dental and domestic partners. Perhaps just as important, we encourage an atmosphere of collaboration, cooperation and collegiality. We know that a diverse workforce with unique experiences and backgrounds makes reputed company stronger. Our patients, members and community come from a wide reputed company of backgrounds, and it takes a diverse workforce to reputed company reputed company easier for reputed company.  We are proud to be an affirmative reputed company, equal opportunity employer and reputed company reputed company applicants will receive consideration for employment regardless to race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, disability or status as a protected veteran. Apply To This Job