Case Manager RN - Remote
Change Healthcare
 Remote, OR

Transforming the future of healthcare isn't something we take lightly. It takes teams of the best and the brightest, working together to make an impact.

As one of the largest healthcare technology companies in the U.S., we are a catalyst to accelerate the journey toward improved lives and healthier communities.

Here at Change Healthcare, we're using our influence to drive positive changes across the industry, and we want motivated and passionate people like you to help us continue to bring new and innovative ideas to life.

If you're ready to embrace your passion and do what you love with a company that's committed to supporting your future, then you belong at Change Healthcare.

Pursue purpose. Champion innovation. Earn trust. Be agile. Include all.

Empower Your Future. Make a Difference.

What will I be responsible for in this job?

This position is required to perform case management activities for health plan members. The activities will include assessing needs, developing a patient-centered care plan, monitoring outcomes, and coordinating interdisciplinary approaches and services. These functions may be performed onsite and/or telephonic. This position works closely with the Health Services Manager and the Medical Director to evaluate, monitor and assure coordination of services, health care coaching and navigation as it relates to condition management, quality, continuity and cost effectiveness. This position is responsible for managing utilization, gaps in care, and performing necessary interventions for positive health outcomes.

Responsibilities also include:

  • Performs assessment, screening, and evaluation of patient's needs.
  • Develops patient-centered care plans
  • Facilitates coordination of care for members in various levels of care to ensure appropriateness and medical necessity.
  • Maintains knowledge of the case management standards of practice, regulatory requirements (i.e. URAC), and state requirements for utilization and case management activities.
  • Initiates case planning meetings and uses an interdisciplinary process in which all members of the health care team collaborate with patients and their families to anticipate needs.
  • Communicates with physicians, providers, family members/care givers, and patients.
  • Utilizes community resources as deemed necessary and maintains on-going relationships with above.
  • Documents care management activities in managed care operating systems

What are the requirements?

  • Registered Nurse with an active nursing licenses to practice in the state of the contracted Client (Arizona or Multi State Nursing License required)
  • Must be able to work the hours of 10:00 a.m - 6:30 p.m. Central Time
  • Minimum of 3-5 years of clinical experience
  • Minimum of 1-2 years of case management or care coordination experience or 2-3 years of utilization management experience
  • Successful work history in a clinical setting and/or health insurance environment
  • Bachelor's Degree in Nursing strongly preferred

What critical skills are needed for you to consider someone for this position?

  • Knowledge of medical appropriateness criteria such as InterQual®, Milliman Care Guidelines®
  • Case Management Certification (CCM) preferred
  • Knowledge of CPT, ICD-10, and/or HCPC codes or coding experience
  • Knowledge of precertification and/or medical review processes in a health care payor or third party environment.
  • Knowledge of URAC or NCQA standards

What other skills/experience would be helpful to have?

  • Strong critical thinking and Analytical
  • Strong verbal and written communication skills
  • Knowledge of healthcare
  • Medical terminology
  • Excellent computer literacy and beginning to moderate skills level with Microsoft Word and Excel
  • Strong interpersonal skills
  • Able to work independently

Join our team today where we are creating a better coordinated, increasingly collaborative, and more efficient healthcare system!

Equal Opportunity/Affirmative Action Statement

Change Healthcare is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, genetic information, national origin, disability, or veteran status. dol.gov/ofccp/regs/compliance/posters/pdf/OFCCP_EEO_Supplement_Final_JRF_QA_508c.pdf.

If you need a reasonable accommodation to assist with your application for employment, please contact us by sending an email to applyaccommodations@changehealthcare.com with “Applicant requesting reasonable accommodation“ as the subject. Resumes or CVs submitted to this email box will not be accepted.

gov/ofccp/pdf/pay-transp_%20English_formattedESQA508c.pdf to view our pay transparency nondiscrimination policy.

Change Healthcare maintains a drug free workplace and conducts pre-employment drug-testing, where applicable, in accordance with federal, state and local laws.