Description: Responsible for case management services within the scope of licensure; develops, monitors, evaluates, and revises the member's care plan to meet the member's needs, with the goal of optimizing member health care across the care continuum Performs telephonic or face-to-face clinical assessments for the identification, evaluation, coordination and management of member's needs, including physical and behavioral health, social services and long-term services Identifies members for high-risk complications and coordinates care in conjunction with the member and health care team Manages chronic illnesses, co-morbidities, and/or disabilities ensuring cost effective and efficient utilization of health benefits; conducts gap in care management for quality programs Assists with the implementation of member care plans by facilitating authorizations/referrals within benefits structure or extra-contractual arrangements, as permissible Interfaces with Medical Directors, Physician Advisors and/or Inter-Disciplinary Teams on care management treatment plans Presents cases at case conferences for multidisciplinary focus Ensures compliance with regulatory, accrediting and company policies and procedures May assist in problem solving with provider, claims or service issues Requirements: Associate or Bachelors Degree in Nursing REQUIRED Registered Nurse (RN) License (Compact or Virginia) REQUIRED 3 years experience in Nursing REQUIRED Case Management experience preferred Managed Care or Health Plan experience preferred Experience in Maternity/OB/Labor & Delivery/Mother Baby/Postpartum/Pregnant population preferred Strong knowledge of physical, psychological, socio-cultural, and cognitive patient needs Excellent communication skills, both oral and written Strong problem-solving and analytical skills Ability to perform telephonic or face-to-face clinical assessments Ability to work standard hours 8am to 5pm EST, Monday-Friday (40 hours/week) Must be located in and eligible to work remotely in Virginia Benefits: Medical, Dental, Vision plans Adoption, Fertility and Surrogacy Reimbursement up to $10,000 Paid Time Off and Sick Leave Paid Parental & Family Caregiver Leave Emergency Backup Care Long-Term, Short-Term Disability, and Critical Illness plans Life Insurance 401k/403B with Employer Match Tuition Assistance $5,250/year and discounted educational opportunities through Guild Education Student Debt Pay Down $10,000 Reimbursement for certifications and free access to complete CEUs and professional development Pet Insurance Legal Resources Plan Opportunity to earn an annual discretionary bonus if eligibility criteria are met Family-friendly culture, community involvement, and professional development opportunities Apply tot his job Apply tot his job Apply tot his job Apply tot his job