Nurse Care Mgr II (contract)

Founded in 1998 on the idea that industry leaders needed a professional service, and workforce management expert, to fuel the development and execution of core business and technology strategies, BCforward is a Black-owned firm providing unique solutions supporting value capture and digital product delivery needs for organizations around the world. Headquartered in Indianapolis, IN with an Offshore Development Center in Hyderabad, India, BCforward's 6,000 consultants support more than 225 clients globally. BCforward champions the power of human potential to help companies transform, accelerate, and scale. Guided by our core values of People-Centric, Optimism, Excellence, Diversity, and Accountability, our professionals have helped our clients achieve their strategic goals for more than 25 years. Our strong culture and clear values have enabled BCforward to become a market leader and best in class place to work.

Anticipated Start Date: 9/29/2025 Please note this is the target date and is subject to change. BCForward will send official notice ahead of a confirmed start date. Responsible for collaborating with healthcare providers and/or consumer to drive personalized health management and improve health outcomes for optimal consumers. Performs care management activities within the scope of licensure for members with complex and chronic care needs. Additional Details: Schedule: Five 8.5 hr shifts Monday-Friday. Various shifts will be offered within the hours of 8am-11pm EST depending on business needs. Some examples of schedules are 9:00am-5:30pm EST, 9:30am-6:00pm EST, split shift 8am-12pm & 4pm-8:30pm EST Candidates with compact license plus one or more states (MI, MA, NY, CT, IL, CA, MN) preferred

Ensures medically appropriate, high quality, cost effective care through assessing the medical necessity of inpatient admissions, outpatient services, out of network services, and appropriateness of treatment setting and level of care. Partners with physician clinical reviewers and/or medical directors to interpret appropriateness of care, intervention planning, and general clinical guidance. Collaborates with providers to assess consumer needs for early identification of and proactive planning for discharge. Conducts clinical assessment to develop goals that address individual needs in order to develop a care plan; implements and coordinates a care plan. Monitors and evaluates effectiveness of the care management plan and modifies as necessary. Assists with development of utilization/care management policies and procedures. Participates in or leads intradepartmental teams, projects, and initiatives.