Care Manager, RN

March 28

⚔️ Virginia – Remote

Although this job is listed in Virginia, this company may be open to hiring remote in other states.

⛰️ West Virginia – Remote

Although this job is listed in West Virginia, this company may be open to hiring remote in other states.

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

Apply Now

Receive Emails with Similar Jobs

Peak Health

WebsiteLinkedInAll Job Openings

Peak Health is a health insurer and health insurance services company headquartered in Morgantown, West Virginia. It is owned by three not-for-profit health care providers: WVU Health System, Marshall Health Network, and Valley Health. Peak Health aims to improve community health outcomes by offering an inclusive, provider-led health plan for residents of West Virginia and surrounding areas. The company is committed to making health care more accessible, understandable, and collaborative, with a focus on reducing costs and administrative fees for patients and employers. Peak Health also offers Medicare Advantage coverage tailored for West Virginia seniors through partnerships with leading health systems.

Health Insurance • Managed Care • TPA Services • Pharmacy Benefit Management • Third Party Administrator

51 - 200 employees

⚕️ Healthcare Insurance

🤝 Non-profit

📋 Description

• Reporting to Manager of Care Management, the Care Manager will be an integral member of the health plan’s medical management team. • Responsible for identifying and connecting high risk members to appropriate resources and programs to achieve optimal quality and financial outcomes. • Responsibilities include managing and triaging self-referrals, identifying high risk members through HRA, reporting and admissions data, auditing patient charts of delegated case management programs to meet accreditation standards, and connect members with in-network providers and resources. • Committed to the constant pursuit of excellence in improving the health status of the community.

🎯 Requirements

• Current unencumbered licensure with the WV Board of Registered Nurse Professional Nurses, or appropriate state board where services will be provided, as a Registered Nurse professional OR Current multi-state licensure through the enhanced Nurse Licensure Compact (eNLC) • Three (3) years of healthcare clinical experience • Bachelor's Degree in Nursing OR Associate of Science in Nursing Degree (ASN) or Diploma; Currently enrolled in a BSN program and BSN completion within three (3) years of hire • Management of Medicare and/or Medicaid populations preferred • Two (2) years Care Management experience