Case Manager, Registered Nurse - Field

• Facilitate delivery of appropriate benefits and healthcare information while promoting wellness activities
• Develop, implement, and support health strategies, tactics, policies, and programs
• Assess, plan, facilitate, coordinate, evaluate, and advocate for members’ and families’ comprehensive health needs
• Act as liaison among members, families, employers, providers, insurers, and healthcare personnel
• Coordinate case management activities for catastrophic cases and chronically ill members across the continuum of care
• Conduct consultant referrals, home care visits, and use community resources and alternative levels of care
• Interact with members telephonically or in person, including in homes, worksites, or physician offices
• Assess medical and/or vocational status and develop plans of care
• Communicate with members and stakeholders, including providers, attorneys, employers, and insurance carriers
• Prepare required case work documentation
• Consult with internal multidisciplinary teams
• Contact treating physicians or specialists regarding care and treatment
• Provide education and prevention information
• Apply laws, regulations, insurer instructions, and referral-source requirements
• Evaluate member needs and benefit-plan eligibility using clinical tools and data
• Facilitate condition management, wellness, medical outcomes, return to baseline, optimal function, and return to work
• Develop proactive action plans and monitor progress toward desired outcomes

• 3+ years clinical practical experience preference
• Ability to travel up to 50% within Chicago, ZIP codes 60616 and 60608
• Active and unrestricted Registered Nurse (RN) license in Illinois (IL)
• Valid and active driver’s license
• Reliable transportation
• Live near ZIP codes 60616 and 60608
• 2+ years case management, discharge planning and/or home health care coordination experience preferred
• Confidence working at home/independent thinker, using tools to collaborate and connect with teams virtually
• Ability to travel within a designated geographic area for in-person case management activities
• Excellent analytical and problem-solving skills
• Effective communication, organizational, and interpersonal skills
• Ability to work independently
• Proficiency with MS Word, Excel, Outlook, PowerPoint, and proprietary applications
• Efficient computer skills, including navigating multiple systems and keyboarding
• Certified Case Manager preferred
• Bilingual in Cantonese/English preferred
• Associate Degree or Nursing Diploma (REQUIRED)

Demonstrates expertise in case management, including assessment, planning, and coordination of care for members with complex health needs. Proficient in applying healthcare regulations and providing education to promote wellness and optimal health outcomes.

• Registered Nurse (RN) License
• Case Management Experience
• Clinical Practical Experience
• Analytical and Problem-Solving Skills
• Bilingual in Cantonese/English

• Case Management
• Health Strategy Development
• Assessment and Planning
• Care Coordination
• Medical Outcomes Evaluation
• Condition Management
• Benefit-Plan Eligibility Evaluation
• Documentation Preparation
• Home Health Care Coordination
• Discharge Planning

• Effective Communication
• Organizational Skills
• Interpersonal Skills
• Independent Thinking
• Problem-Solving

• Certified Case Manager
• Registered Nurse (RN) License

• Healthcare Information
• Wellness Activities
• Community Resources
• Continuum of Care
• Telephonic Interaction
• Liaison
• Clinical Tools
• Regulations
• Home Care Visits
• Member Advocacy

• MS Word
• MS Excel
• MS Outlook
• MS Power Point
• Proprietary Applications