Responsible for evaluating and pre-certifying provider requests, handling multiple telephonic interactions, and coordinating referrals to case management services.
Responsibilities
Evaluate and pre-certify provider requests
Review requests and match to evidence-based guidelines
The Case Manager RN role is 100% remote work from home and candidates must have an active Illinois RN licensure (but does not need to live in Illinois).
Compensation
$66,575.00 - $142,576.00
Responsibilities
Develops a proactive course of action to address issues presented to enhance the short and long-term outcomes as well as opportunities to enhance a member’s overall wellness through integration.
Through the use of clinical tools and information/data review, conducts an evaluation of member’s needs and benefit plan eligibility and facilitates integrative functions as well as smooth transition to Aetna programs and plans.
Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and barriers and address complex health and social indicators which impact care planning and resolution of member issues.
Assessments take into account information from various sources to address all conditions including co-morbid and multiple diagnoses that impact functionality.
Reviews prior claims to address potential impact on current case management and eligibility.
Requirements
Associate’s degree in nursing is minimum required. BSN preferred.
Nice to have: case management experience
Nice to have: multiple state RN licensure
Nice to have: Certified Case Manager (CCM) certification
Lead day‑to‑day operations of a single Kay Jewelers store, driving sales, profitability, customer satisfaction, inventory control, brand representation, and team development.
Compensation
Base pay, $50,000 – $67,750 plus commission on sales.
Responsibilities
Lead store operations to achieve sales and profitability goals
Coach and develop store staff to deliver best‑in‑class customer experience
Maintain inventory control and visual merchandising
Ensure compliance with company policies and procedures
Manage scheduling and staffing
Requirements
College degree
Nice to have: Specialty retail or jewelry experience
Nice to have: Diamond Council of America (DCA) certification
Responsible for delivering high‑quality customer service through telephone and digital channels, ensuring that customer queries are addressed promptly and resolved efficiently.
Responsibilities
Provide accurate product information to existing client base via telephone and written communications
Drive significant growth and profitability through cost management
Manage costs and expenses within approved budget
Deliver exceptional service that exceeds customer expectations
Resolve all customer queries efficiently and within agreed timelines
The Care manager works closely with members and their caregivers to promote habits to improve quality of life and attainment of health goals using a Whole Person Care approach. The Care Manager creates a customized plan to meet the clients’ key risks through collaborative approach with the clients and their caregivers.
Responsibilities
Telephonically assess Medicare, Medicaid, and/or and Group Account members and create actionable and measurable care plans to help guide and track the members' progress toward goals
Use nursing judgment to assess and coordinate care for acute situations (APS, EMS)
Discuss transitions of care to assist with safe discharge to the home and coordinate care for DME, home health, provider appointments, etc.
Guide members and their families toward and facilitate interaction with resources appropriate for the care and wellbeing of members
Assess member’s physical, environmental and psycho-social health issues and work in collaboration with a multi-disciplinary team, such as social workers, dietitians, pharmacists, etc., employing a variety of strategies/techniques to manage appropriately and provide timely intervention
Responsible for performing care management within the scope of licensure for members with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum.
Locations (2)
New York, New York, United States
Virginia, United States
Compensation
For candidates working in person or virtually in the below locations, the salary* range for this specific position is $67,200 to $120,960
Responsibilities
Ensures member access to services appropriate to their health needs
Conducts assessments to identify individual needs and a specific care management plan
Implements care plan by facilitating authorizations/referrals
Coordinates internal and external resources to meet identified needs
Monitors and evaluates effectiveness of the care management plan and modifies as necessary
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