Case Management Nurse

Job Title: Registered Nurse (RN) Case Manager – Remote (Missouri Residents Only) Location: Remote (Must reside in Missouri) Schedule: Monday – Friday, 8:00 AM – 5:00 PM CST Position Summary: The Case Manager RN utilizes a collaborative process of assessment, planning, facilitation, and advocacy to coordinate services and resources that align with an individual's benefit plan and/or health needs. This role focuses on promoting optimal, cost-effective outcomes through effective communication and clinical judgment.

Conduct comprehensive assessments of referred members' needs and eligibility using clinical tools and data analysis. Determine the best course of action to address member needs based on benefit plans and internal/external programs. Apply and interpret relevant criteria, guidelines, and standardized case management plans. Ensure the appropriate administration of member benefits in compliance with applicable policies, procedures, and regulatory standards. Utilize case management and quality management processes to support accreditation and regulatory compliance. Maintain effective communication with members and interdisciplinary teams. Navigate multiple systems for documentation, research, and case management tasks.