Case Manager; WTCHP

Position: Case Manager (WTCHP)

Registered Nurse / Case Manager (WTCHP) – BeVera Solutions

BeVera Solutions LLC is a rapidly growing public health and professional services company that provides innovative solutions to federal and state agencies. We support mission‑critical programs through expertise in program management, communications, acquisition, data analytics, and public health initiatives.

Recognized as one of Atlanta’s Best Places to Work (2024 & 2025) by the Atlanta Business Chronicle, BeVera fosters a culture of integrity, excellence, and collaboration.

BeVera Solutions LLC is seeking a full‑time, detail‑oriented, and compassionate Registered Nurse / Case Manager to support member‑centered health services through comprehensive care coordination, utilization support, and member advocacy.

THIS ROLE IS PART OF A PRE‑AWARD CANDIDATE SEARCH FOR AN UPCOMING FEDERAL GOVERNMENT CONTRACT.

Member Care Coordination

• Provide individualized case management services tailored to each member’s clinical, social, and administrative needs.
• Coordinate medical monitoring, diagnostic services, and treatment for members receiving care through the Nationwide Provider Network (NPN).
• Assist members in navigating the WTCHP care continuum, including understanding benefits, treatment pathways, and required documentation.
• Support continuity of care by coordinating among NPN providers, the Third‑Party Administrator (TPA), Pharmacy Benefits Manager (PBM), and WTCHP Program staff.

Clinical and Non‑Clinical Case Management

• Deliver both standard and intensive case management services in accordance with WTCHP Case Management and Utilization Management Standard Operating Procedures.
• Identify barriers to care such as geographic access, provider availability, coordination of benefits, or member adherence, and implement strategies to mitigate those barriers.
• Promote efficiency and appropriate utilization of services while supporting high member satisfaction and positive health outcomes.
• Encourage and support member self‑management of care over time, as clinically appropriate.

Utilization and Authorization Support

• Collaborate with NPA utilization management staff to support prior authorization processes related to certified WTC‑related conditions.
• Review clinical documentation and supporting information to ensure services align with Program coverage requirements.
• Monitor trends in utilization and member needs and communicate emerging issues to leadership to inform program improvements.

Member Advocacy and Issue Resolution

• Serve as an advocate for members by addressing concerns, resolving care coordination issues, and facilitating communication among stakeholders.
• Assist members in understanding Program policies, rights, responsibilities, and appeals processes.
• Support outreach efforts to re‑engage inactive or hard‑to‑reach members.

Documentation and Data Management

• Maintain accurate, timely, and compliant case records within the NPA’s secure data and document management systems.
• Ensure documentation complies with HIPAA, WTCHP privacy requirements, and National Archives and Records Administration (NARA) digitization standards.
• Participate in bidirectional data exchanges with WTCHP and other Program contractors to ensure consistency and accuracy of member information.

Quality Management and Continuous Improvement

• Participate in quality assurance activities, audits, and performance monitoring initiatives.
• Contribute to continuous improvement efforts by identifying trends, systemic issues, and opportunities to enhance member experience and care coordination.
• Complete required training and maintain up‑to‑date knowledge of WTCHP policies, procedures, and evolving Program requirements.

Educational and Experience Qualifications

• Minimum education:
  
  Bachelor’s degree in Nursing, Social Work, Public Health, Health Administration, or a related field (Master’s degree preferred).
• Minimum of 3–5 years of experience in healthcare case management, care coordination, or utilization management.
• Must be a licensed Registered Nurse (RN).
• Must possess active clinical licensure (e.g., RN, LCSW, LMSW, or equivalent).
• Multi‑State (NLC) RN licensure preferred.
• Demonstrated experience working with complex medical…