Job Description

The Non-Clinical Case Manager is designated as key personnel and is responsible for coordinating, monitoring, and evaluating member care services to ensure quality, cost-effectiveness, and compliance with regulatory and organizational standards. This role focuses on care coordination, resource management, and interdisciplinary collaboration rather than direct clinical treatment.

The Case Manager must hold Registered Nurse III (RN III) status and demonstrate advanced clinical knowledge, strong critical thinking skills, and expertise in case management principles.

Essential Duties and Responsibilities

• Conduct comprehensive, non-clinical assessments to identify member needs and service gaps
• Develop, implement, and monitor individualized care plans in collaboration with members, families, providers, and interdisciplinary teams
• Coordinate healthcare services across multiple providers and settings
• Facilitate appropriate utilization of healthcare resources
• Monitor member progress and adjust care plans as needed
• Ensure compliance with regulatory requirements and organizational policies
• Maintain accurate and timely documentation of case management activities
• Provide education and guidance to members regarding available services and community resources
• Participate in quality improvement initiatives and performance monitoring activities
• Serve as a liaison between members, providers, payers, and community partners

Knowledge, Skills, and Abilities

• Strong critical thinking and analytical skills
• Excellent communication and interpersonal skills
• Ability to work independently and manage multiple cases effectively
• Knowledge of care coordination models and utilization review processes
• Proficiency in documentation and case management software systems
• Ability to interpret clinical information for care planning and service coordination

Work Environment

• Primarily office-based
• Minimal travel may be required
• No direct patient care responsibilities

Requirements

• Current, unrestricted Registered Nurse (RN) license
• Minimum of two (2) years of case management experience
• Minimum of three (3) years of clinical nursing experience
• Strong knowledge of healthcare systems, utilization management, and care coordination practices

Benefits

• Health Care Plan (Medical, Dental & Vision)
• Retirement Plan (401k, IRA)
• Life Insurance (Basic, Voluntary & AD&D)
• Paid Time Off (Vacation, Sick & Public Holidays)
• Short Term & Long Term Disability
• Training & Development

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