Case Management Nurse I

Summary

Join Wellmark as a Case Management Nurse I and become a key advisor, actively engaging with members to support their complex healthcare needs. You will create individualized care plans, collaborating with members, families, and providers. This role requires strong communication, time management, and technical skills, including proficiency in Microsoft Office products. Candidates located in Iowa or South Dakota are preferred, and obtaining CCM certification within 24 months is required. The position is remote eligible, requiring high-speed internet. Wellmark offers a unique benefits package.

Requirements

• Completion of an accredited nursing program
• Active and unrestricted RN License in Iowa or South Dakota. Individual must be licensed in the state in which they reside
• Certified Case Manager (CCM); must obtain within 24 months of hire
• 4+ years of diverse clinical experience (e.g., acute care, outpatient, home health, etc.) that reflects 4+ years of direct clinical care to the consumer. Experience in utilization management or health insurance setting beneficial
• Strong verbal communication skills; influences action and facilitates crucial conversations regarding care with members, physicians, and care facilities
• Maintains courtesy and professionalism when engaging with members, internal and external stakeholders
• Strong written communication skills, including accurate documentation of events within the case management platform; ensures quality and consistency by following guidelines and processes
• Commitment to service excellence and member advocacy; uses critical thinking and problem-solving skills to anticipate member and provider needs
• Resourceful self-starter who demonstrates strong understanding of resources, processes, and guidelines. Able to make independent decisions or recommendations under ambiguity
• Ability to organize and manage multiple priorities in a dynamic work environment where quality and/or production goals are measured. Commitment to timeliness, follow up, accuracy and attention to detail. Flexible and adapts to change
• Strong technical acumen; learns new systems quickly - e.g., Microsoft Office, clinical documentation platforms, etc
• Knowledge of standards and regulations - e.g., URAC, NCQA, HIPAA, PHI confidentiality

Responsibilities

• Utilize critical thinking to recognize signs and symptoms of potential high-risk and complex conditions that warrant different or greater levels of support and proactively anticipate member needs in the navigation of the health care system and the benefits and resources available
• Discuss the care needs with the member through supportive, focused intervention methods and effective planning techniques
• Proactively identify barriers and gaps to care while designing, creating, and managing unique, individualized care plans that ensure members/providers have good communication channels, that members receive appropriate care, that potential duplication of services is avoided, and education is provided to help enable them to achieve the best possible health care goals
• Partner with members, members’ families, health care providers and community resources to coordinate and facilitate the care and services needed
• Actively engage members as participants in their unique care management plan and educate on their personal accountabilities and expected outcomes. Advise on included benefits and services that are appropriate for their current medical status, and how those benefits and services can positively impact not only their medical status, but also the total cost of care
• Stay curious and engaged by actively continuing to partner with other members of the Wellmark Team and research appropriate resources and/or programs as science and technology evolves, that may help to improve the health of assigned members going forward. Continue collaborative efforts with other clinical and nonclinical stakeholders, both internal and external to Wellmark, to provide optimal service and meet the needs of the member and coordinate care. Facilitate additional referrals to providers, community resources/programs, and specific Wellmark programs, as necessary
• Using relevant technology tools, document care management activities accurately, consistently, and timely by following the standard work guidelines and policies to support internal and external processes. Comply with regulatory standards, accreditation standards and internal guidelines. Remain current and consistent with the specific standards pertinent to the Care Management team
• Other duties as assigned
• Must be flexible and have the ability work weekend and/or holiday hours when needed on a rotational basis

Preferred Qualifications

• Certified Case Manager (CCM)
• Care navigation/care coordination experience strongly preferred

Benefits

Remote Eligible: You will have the flexibility to work where you are most productive. This position is eligible to work fully remote. Depending on your location, you may still have the option to come into a Wellmark office if you wish to. Your leader may ask you to come into the office occasionally for specific meetings or other ‘moments that matter’ as well