Managed Care Case Manager, RN

GuideWell Source

Managed Care Case Manager remotely aiding members in navigating health care options and achieving health goals. Collaborating with care teams and using digital tools for effective member engagement.

Posted 5/22/2026full-timeRemote • 🇺🇸 United StatesJuniorMid-Level💰 $71,200 - $115,700 per yearWebsite

About the role

Key responsibilities & impact

This key position is responsible for assisting members within a geographical (local, statewide and/or other) area make effective health care choices for self-management of their acute and /or chronic condition(s).
Utilizing a member-centric approach they assist members and their families understand and manage their disease process by: reinforcing the physicians' plan of treatment, promoting healthy behaviors and lifestyle changes, and providing education and tools to promote self-management to improve health outcomes and reduce overall costs.
Individual care plans are developed in collaboration with the Physician, Member/Care Giver, Families and the Care Team.
Ongoing coaching, monitoring and evaluation of care plans will be done face to face with the member, telephonically, digital engagement or electronically through email and member and provider portals.
Engage Members telephonically, using digital engagement tools and/or face to face at Florida Blue Retail Centers, hospitals, etc. with a focus on health coaching and member education. Facilitate access to care and resources to meet the member’s health care needs. Provide education and tools to promote self-management.
Plan, implement, coordinate and monitor Case Management activities that may include acute and non-acute services, outpatient services, behavioral health and / or community resources.
Facilitate care for high risk members across the continuum of the health care experience, including care transitions, coordination of community and social service and coordinating with other value-based organizations, providers as needed.
Close gaps in care
Conduct Medication Reconciliation
Collaborate with Member, Member’s Physicians, Plan Medical Directors, Managers, Local, Regional and Specialty team members as well as other functional areas to assist the member to meet their health care goals.
Promote healthy lifestyles, assist in strengthening the patient-physician relationship, encourage behavior and lifestyle changes to realize a better quality of life, for individuals with identified chronic conditions, costly and/or catastrophic illnesses.
Assist Members and their physicians to navigate through the health continuum, educate regarding benefits, identify candidates for Care Programs and provide information pertaining to the network and network access.

Requirements

What you’ll need

RN - Registered Nurse - Active and Unrestricted State Licensure And/Or Compact State Licensure
2+ years related work experience. Experience Details: Communicating and building relationships with members/providers/employers both telephonically as well as live
Related Bachelor’s degree or additional related equivalent work experience
Experience with influencing and motivating individuals to change health behaviors
Knowledge and/or experience with population health
Experience in two or more of the following: home health care, utilization review, discharge planning, disease/ case management
Experience working with Managed Care products, benefits and services
Experience in planning, implementing coordinating and monitoring activities that focus on acute and non-acute services, outpatient services and/or community resources for all lines of business
Non-traditional working hours to meet the member's availability
Basic to intermediate experience in MS Word, Excel, tablet and/or smartphone .Basic technology skills with digital tools and apps.
Travel up to 30% (subject to change) for on-site member/provider/employer meetings, events or manager requests with occasional overnight stays
Must have valid driver's license and reliable transportation

Benefits

Comp & perks

Medical, dental, vision, life and global travel health insurance;
Income protection benefits: life insurance, short- and long-term disability programs;
Leave programs to support personal circumstances;
Retirement Savings Plan including employer match;
Paid time off, volunteer time off, 10 holidays and 2 well-being days;
Additional voluntary benefits available;
A comprehensive wellness program

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

Registered NurseMedication ReconciliationCase ManagementDisease ManagementUtilization ReviewDischarge PlanningPopulation HealthHealth CoachingBehavior ChangeHealth Education

Soft Skills

CommunicationRelationship BuildingInfluencingMotivatingCoachingCollaborationMonitoringEvaluationOrganizationalProblem Solving

Certifications

Active RN LicenseCompact State Licensure