Job Description

Job Description

Job Description

Description:

TEAM Wellness Corporation is looking for a Nurse Case Manager to provide services to keep patients in the best physical condition by working both proactively and reactively. As a Nurse Case Manager, you will be responsible for overseeing and coordinating short-term and long-term medical care for patients and act as a member of the clinical team. At TEAM Wellness Corporation, we take a holistic approach to understanding client issues and have been providing quality employee assistance program services for members of the building trades for over 30 years.

The position is Monday-Friday, Full Time/In-Office. The Nurse Case Manager’s salary is $75,000 -$90,000/year, commensurate with education and experience.

Education:

• Bachelor of Science in Nursing (BSN) or Registered Nurse (RN) degree from an accredited college or university required.

Experience:

• Experience in medical management, clinical nursing, case or disease management, health benefit plans, health insurance, home care services, or related field is required.
• Telephone triage or call center background is a bonus.
• Bilingual in Spanish is a bonus.

Essential Job Responsibilities

• Provide telephonic, video, and on-site case management for patients with high-acuity and/or co-morbidities.
• Facilitate access to healthcare providers, benefits information, and health resources.
• Communicate clear, non-prescriptive messages about medical procedures and timelines to members.
• Build relationships with members to develop collaborative action plans.
• Coordinate communication among members, providers, and insurers, ensuring clarity on health questions and plan provisions.
• Monitor the medical necessity and efficiency of care, collaborating with clinicians and medical directors as needed.
• Participate in care coordination meetings to address delays and barriers.
• Uphold TEAM values and continuous quality improvement in all tasks.
• Stay informed about available benefits, community resources, and coverage information.
• Maintain continuity of care through communication among patients, families, and providers.
• Coordinate patient transfers to in-network facilities as appropriate.
• Keep current with case management practices and relevant policies.
• Ensure confidentiality of sensitive information.
• Discuss cases not meeting medical necessity with the care team and clinical director.
• Serve as a liaison for coordinating care transitions with other agencies.
• Identify and refer complex cases to supervisors for review.
• Record, monitor and report data such as clinical outcomes achieved, potentially avoidable and medically necessary variances, length of stay, reviews completed and outcomes, and discharge dispositions daily.
• Collaborate with care team and attending provider to create actionable care and discharge plans.
• Assess eligibility, benefits, and ongoing care needs for each case.
• Function independently and as part of a team, working effectively with various departments, internal and external staff, facilities, clients, clients’ families, and providers to facilitate quality and efficient client care.
• Provide on-site assessments based on assignment or request.
• Provide assessments for clients referred on a mandated/formal basis by employers or unions. Solicit perspectives of the referring party as well as the client.
• Explain benefits and resolve errors with providers and health plans.
• Complete other assigned duties and projects.

The Nurse Case Manager position is an exempt position and includes benefits such as the following:

• 401(k) and 401(k) Matching
• Low Deductible Health and Dental Benefits
• Life Insurance
• Liability and malpractice insurance
• License Reimbursement
• Tuition reimbursement
• Employee Assistance Program
• Flexible Spending Account
• Free Parking
• Paid time off

License/Certification:

• RN Minnesota License (Required)

Ability to Relocate:

• Minneapolis, MN 55435: Relocate before starting work (Required)

Job Tags

Similar Jobs