Job Description

Imagine360 is seeking a RN Case Manager to join the team! This position is responsible for coordinating and facilitating cost effective management of health care resources for CareLink program members in order for the member to achieve an optimal outcome in their health. The RN Case Manager utilizes tools and resources to identify individuals and cases for clinical/financial interventions. This position maintains a comprehensive understanding of self-funding and healthcare reimbursement strategies under their scope of responsibility.

Position Location: 100% remote

Responsibilities include but are not limited to:

• Performs essential activities of case management while maintaining members' confidentiality, safety, advocacy, adherence to ethical, legal and accreditation and regulatory standards.
  • Performs assessment by identifying members that meet criteria for CareLink Advanced and financial savings programs within the claims department.
    • Consistently exercises discretion and judgment to analyze, interpret, make deductions and then decide what actions are necessary based on the varying facts and circumstances of each individual case.
  • Determines measurable goals utilizing motivational interviewing and behavior change model and coaches clients while monitoring self-care practices.
    • Utilizes industry standard tools to guide individuals with chronic/ongoing health conditions through coaching, assessments, listening, and other techniques as appropriate
  • Executes activities or interventions to achieve the goals in the plan
  • Organizes, integrates and modifies the resources needed to reach the goals in the plan.
  • Monitors all information from all relevant sources in the plan and its activities and services to determine the plan's effectiveness.
  • At repeated intervals, evaluates to determine ultimate effectiveness of plan and modifies plan appropriately to meet the goals.
    • Researches medical procedures, treatments and coding when necessary.
  • Measures the outcomes of interventions.
  • Adheres to practicing the care management core components throughout the continuum of care:
    • Case Management Concepts
    • Case Management Principles and Strategies
    • Psychosocial and Support Systems
    • Healthcare Management and Delivery
    • Healthcare Reimbursement
    • Vocational Concepts and Strategies.
  • Customer Service
    • Acts as a role model in demonstrating the core values in customer service delivery.
    • Provides timely and thorough follow up with, internal and external customers.
    • Appropriately escalates difficult issues up the chain of command.
  • Quality Assurance
    • Serves on committees, work groups, and/or process improvement teams, as assigned, to assist in improving quality/customer satisfaction.
    • Recognizes and alerts appropriate supervisor of trends within their scope of responsibility that fall outside of quality parameters.
    • Performs self-quality monitoring in order to develop and execute plans to meet established goals.
    • Provides ongoing feedback to help optimize quality performance.
    • Collaborates with others and cross-departmentally to improve or streamline procedures.
    • Develops new or improves current internal processes to improve quality.
    • Spends up to 15% of time on quality assurance.

Required Experience/Education:

• A nursing degree from an accredited college, university, or school of nursing.
• 2+ years clinical experience as a Registered Nurse
• Case Management experience or transferable skills.

Skills and Abilities:

• Working knowledge of computers and software including but not limited to Microsoft Office products
• Proficient typing skills
• Demonstrated organizational skills, problem-solving, analytical skills and detail oriented
• Strong written, oral and telephonic communication skills
• Demonstrated ability to work independently, prioritize workloads multi-task and manage priorities to meet deadlines
• Ability to maintain the confidentiality of protected health information in compliance with HIPAA regulations.

License and Certifications:

• Must maintain active, current, and unrestricted Registered Nurse license and CEU's as required by the State Board of Nursing. Must be willing to obtain and maintain additional license(s) as required to perform the job functions of the organization.
• Must obtain Certified Case Manager (CCM) designation within 3 years of hire.

What can Imagine360 offer you?

• Multiple Health plan options
• Company paid employee premiums for disability and life insurance
• Parental Leave Policy
• 20 days PTO to start / 10 Paid Holidays
• Tuition reimbursement
• 401k Company contribution
• Company paid Short & Long term Disability plus Life Insurance
• Professional development initiatives / continuous learning opportunities
• Opportunities to participate in and support the company's diversity and inclusion initiatives

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Imagine360 is a health plan solution company that combines 50+ years of self-funding healthcare expertise Over the years, we've helped thousands of employers save billions on healthcare. Our breakthrough total health plan solution is fixing today's one-size-fits-none PPO insurance problems with powerful, customized, member-focused solutions.

Imagine360 is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status.

**RECRUITMENT AGENCIES PLEASE NOTE: Imagine360 will only accept applications from agencies/business partners that have been invited to work on a specific role. Candidate Resumes/CV's submitted without permission or directly to Hiring Managers will be considered unsolicited and no fee will be payable. Thank you for your cooperation**