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Case Manager, RN (Remote)

Remote: 
Full Remote
Contract: 

Offer summary

Qualifications:

Three or more years of clinical experience in the Behavioral Health field., Active, current, and unrestricted professional licensure as a Registered Nurse (RN) in MA, ME, NH, or state of residency., Experience with utilization management utilizing standardized criteria such as InterQual or MCG., Strong communication skills to interact with members, physicians, and healthcare professionals..

Key responsabilities:

  • Coordinate services and manage healthcare resources to meet individual members' needs.
  • Communicate with members and healthcare professionals regarding the Care Management process.
  • Conduct telephonic assessments for Discharge Outreach services and ensure safe transitions of care.
  • Document Case Management outcomes and advocate for services within health benefit plan constraints.

Health Plans Inc logo
Health Plans Inc Insurance SME https://hpitpa.com/
201 - 500 Employees
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Job description

Do you envision working for a company that has the expertise of a long-standing industry leader, but the spirit of an entrepreneur? Does the thought of making a real impact motivate and energize you? If so, HPI is the place for you. Join a team that values integrity, flexibility, loyalty, compassion and dedication—we can’t wait to meet you.

 

What we do

HPI is unique. A respected industry leader that’s been serving customers for over 40 years, we’re known for our innovation and growth. Our experience has given us our expertise, but our forward-thinking, entrepreneurial spirit has given us our strong reputation. As a third-party administrator, we offer a suite of health and benefit solutions to employers. By joining HPI, you’ll contribute to ideas that make a real difference for employers and employees nationwide. There isn’t a challenge we won’t accept and we’re looking for people who have a passion to take it on. Not just a job—a mission.

 

What you’ll do

The Case Manager is responsible for the coordination of services and cost-effective management of health care resources to meet individual members' health care needs and promote positive health outcomes. 


In this role, you’ll also: 

  • Communicate with members/designees, physicians and other health care professionals regarding the Care Management process including information about the role of HPI and the Case Management program.
  • Telephonically assess members referred for Discharge Outreach services, for purposes of problem identification and referral to Case Management,  when assigned to the Discharge Outreach Program, to ensure safe transition to the next level of care upon discharge
  • Determine and document quantifiable Case Management outcomes, including avoidable and actual dollar savings.
  • Advocate for options and services within the constraints of the health benefit plan to meet members’ health care needs.
  • Promote and facilitate excellent communication among the member/designee, family and health care team.
  • Continually educate and enable the patient/family in order to promote self-management and self-advocacy.
  • Research available community resources and alternative funding sources as appropriate.
  • Identify quality of care issues and escalate concerns to Management as appropriate.
  • Ensure documentation is objective and accurate.
  • Conduct utilization management of appropriate level of care and length of stay using standardized clinical criteria.
  • Consult with Physician Reviewers and other experts to determine appropriateness of care as needed.
  • Comply with all HIPAA standards for documentation, security and privacy.

What you bring

  • Three or more years’ clinical experience in the Behavioral Health field
  • Active, current, and unrestricted professional licensure Registered Nurse (RN) in MA, ME, NH, or state of residency
  • Experience with utilization management utilizing standardized criteria such as InterQual or MCG

 

Why choose us?

  • We offer our employees flexible work arrangements including remote and hybrid options (depending on the position)
  • We are a people-first company and value giving back to our community. Ask us about our RISE Committee & and volunteer opportunities.

 

Benefits

We care about you and believe the greatest gift you can give yourself, your family, and the world is a healthy you! We offer a comprehensive and competitive benefits package to help you lead a happy, healthy life. Check out some of the benefits we offer:

  • Medical, Dental and Vision Coverage
  • Prescription Drug Coverage
  • Fitness Reimbursement Benefit
  • Tobacco Cessation Program
  • Employee Assistance Program
  • Flexible Spending Account & Health Savings Account
  • 401(k) and Profit-Sharing Plan
  • Quarterly Bonuses
  • Generous Paid-Time Off 
  • Volunteer Days
  • Educational Assistance & Professional Development Opportunities
  • ….and much much more!

 

So, do you want to join the HPI team? We hope to hear from you!

 

You can read more about us at hpitpa.com/about-us/careers/

 

EEO/AA/M/F/Vet/Disability Employer 

Required profile

Experience

Industry :
Insurance
Spoken language(s):
English
Check out the description to know which languages are mandatory.

Other Skills

  • Compassion
  • Teamwork
  • Physical Flexibility
  • Problem Solving

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