Imagine360 is currently seeking a Behavioral Health RN Case Manager to join our team. The Behavioral Health RN Case Manager is responsible for delivering case management services to individuals covered by group health plans administered by imagine360, drawing on nursing education, clinical experience, and professional judgment. The RN is a dedicated case manager serving patients with behavioral health, mental health, and\/or neurodevelopmental disorder needs. They adhere to department criteria, collaborating with physicians, providers, members, and other stakeholders to assess, plan, coordinate, monitor, evaluate, and advocate for necessary options and services to address comprehensive health needs of individuals and families. They leverage communication and resources to enhance quality and cost-effective outcomes, acting as a liaison to providers, physicians, and members. The Registered Nurse operates within the scope of nursing practice while fulfilling these responsibilities.\n

Who we are: At Imagine360, we are fixing health insurance. To help\u202fbusinesses and their employees\u202fnavigate through\u202fclutter and chaos\u202fand\u202fbring deep cost savings\u202fthat\u202fprotect\u202feveryone's\u202fwell-being and budgets.\u202fIt's way more\u202fthan a health plan. It's a promise.\u202f For more than 12 years, we've helped hundreds of self-funded clients use reference-based pricing to maximize savings and control costs. Our approach is proven. Our solutions are ready to implement. The results are real. \n

Specialties: Plan Design, Direct Contracting, Claims Auditing, Designated Decision Making, Member Advocacy and Defense, Analytics, Self-Insurance, and Healthcare Cost Containment. \n

Position Location: 100% Remote\n

Responsibilities include but are not limited to:\n\nIdentify, collect, process, and manage data to perform the Case Management process by utilization Imagine360 approved clinical guidelines and following Medical Management Policy and Procedures\nConducts comprehensive clinical assessments according to established policies and procedures to identify and provide appropriate care and coordination of behavioral health, mental health, neurodevelopmental disorder diagnoses.\nManage members with behavioral health, mental health, neurodevelopmental disorder diagnoses, and for members with medical diagnoses that also have behavioral health, mental health, neurodevelopmental disorder diagnoses. \nUtilize clinical knowledge, expertise, and educational resources to provide verbal and\/or written educational resources to members regarding diagnosis, procedures and\/or treatment.\nAssess the need for and collaborate with community resources for members in case management. \nUses assigned software accurately to document and complete all steps of review of medical necessity and case management processes, including time slips.\nFacilitate the Patient Satisfaction Surveys\nAssess for cost savings and document the cost savings in assigned software platform.\nAppropriately escalates complex cases to Supervisor, Case Management, or designee as needed.\nPerforms essential activities of case management while maintaining members' confidentiality, safety, advocacy, adherence to ethical, legal, accreditation and regulatory standards. \nPerform other duties and projects, as assigned.\n\n

Required Experience and Education:\n\nNursing degree from an accredited college, university, or nursing school. \n3+ years' experience working with Behavioral\/Mental Health patients or programs. \n1+ years in Case Management, discharge planning or managed care experience or transferrable nursing experience and skills. \n\n

Preferred Education and Experience:\n\nBachelor's degree in nursing preferred but not required. \nExperience with Utilization Management and standardized criteria.\nExperience working in a URAC accredited Case Management program \nExperience working within an insurance agency or TPA specializing in employee benefits and self-funded medical plans. \n\n

Licenses or Certifications:\n\nAn active unrestricted Registered Nurse License in eNLC compact state. Must maintain CEUs as required by applicable State Board(s) of Nursing and required certifications. Must be willing to obtain and maintain additional license as required to perform the organization's job functions. \nCase Management Certification (CCM) - preferred \n\n
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What can Imagine360 offer you?\n\nMultiple Health Plan Options, including a 100% Employer Paid Benefit Options\n100% Company paid employee premiums for Dental, Vision, STA, & LTD, plus Life Insurance\nParental Leave Policy \n20 days PTO to start \/ 10 Paid Holidays \nTuition reimbursement \n401k Company contribution \nProfessional development initiatives \/ continuous learning opportunities \nOpportunities to participate in and support the company's diversity and inclusion initiatives\n\n
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Imagine360 is a health plan solution company that combines 50+ years of self-funding healthcare expertise. Over the years, we've helped thousands of employers save billions on healthcare. Our breakthrough total health plan solution is fixing today's one-size-fits-none PPO insurance problems with powerful, customized, member-focused solutions.\n

Imagine360 is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status.\n

**RECRUITMENT AGENCIES PLEASE NOTE: Imagine360 will only accept applications from agencies\/business partners that have been invited to work on a specific role. Candidate Resumes\/CV's submitted without permission or directly to Hiring Managers will be considered unsolicited, and no fee will be payable. Thank you for your cooperation**