RN Case Manager

Job Description Job Description Company Website: http://www.90degreebenefits.com/ Company Summary: 90 Degree Benefits, is a health care benefit plan asset manager for self-funded employer plan sponsors. The Company employs a fully integrated, comprehensive medical risk management program that improves health care outcomes for plan participants and significantly reduces claim cost for employer clients. Position Summary: 90DB is seeking a full-time RN Case Manager to join our company and work with the clinical team in our Charlotte, NC, office. This exempt level position is responsible for case management, utilization review, wellness education and mentoring, authorizing medical procedures, and disease management of our client's members. In addition, this position will monitor, identify, and report on health and financials risks as it relates to our clients, SL renewals, and management reports. CCM certification preferred; must obtain within two years. Essential Duties and Responsibilities: Acquire member information and maintain records and proficiency in the use of the clinical and claims software programs to include CedarGate (Plan Analytics, Care Manager and Health Portal) and VBA (claims systems utilized). Review policyholder data to identify claimants with catastrophic care needs and assess medical & claims information available to calculate potential risk. Complete disclosure reporting and review. Identify potential large loss claims through the UR process, predictive modeling, CedarGate Plan Analytics Cohorts, claims referral, pending claim reports, customer service referral, client referral, and other methods as indicated, and keep Clinical and Senior Management informed. Assure high risk and potential large loss individuals are flagged in Care Manager system for SL reporting, evaluated for SL notification/reporting, and referred for ongoing case management. Provide support to the SL Claims Department for timely notification of potential large claims, evaluation of cases for assessment of ongoing claim potential, and status reports for continuing cases. Provide support to the SL Marketing Department for contract renewal reports and for preparation and submission of group renewals. Generate renewal reports, including the SL/Case Management Summary, Trigger Diagnosis, Precert, and Discharge reports. Provide reports for inclusion in group’s SL renewal and/or management report packet. Participate in client meetings, broker meetings, and renewal meetings regarding the clinical aspect of SL renewals. Respond to verbal or written requests from the SL underwriting staff for additional clinical information or clarification during the underwriting process. Provide consultation to account managers, provider relations, claims, marketing and customer service departments, as indicated, to promote and improve the goals and objectives of CBS. Assist Clinical team to review medical records and process authorizations for surgery or precerts. Assist with health fairs, creating literature, and promoting wellness with the employees of our clients. Perform other activities and functions, as requested by President. Maintain licensure, certification, and continuing education as indicated for case management, utilization review, wellness, and chronic condition management programs and the professional staff. Qualifications: Bachelor’s degree (or higher) in Health Care Administration, Nursing or related field from a four-year college or university or equivalent combination of experience and education; current RN License required. Two - four (2-4) years of management experience in utilization review/case management in the self-insured environment - Preferred. Experience with TPA, SL reinsurance contract administration, risk management and quality assessment preferred. Case Management certification (CCM) Preferred. . Utilization Management, Disease Management and/or Wellness Certification considered a plus. Understanding of legal and ethical issues pertaining to confidentiality and liability associated with utilization management, case management, wellness plans, and benefit administration. Data analytics and report preparation experience and the ability to explain findings to clients. Excellent communication skills; ability to write procedures, reports, and correspondence and speak effectively in group presentations and training seminars. Strong organizational skills; ability to work with multiple projects simultaneously and complete assignment within prescribed time frame. Ability to deal with problems and apply understanding to complex administrative issues. Physical Requirements: Lift and move a minimum of 20 pounds without assistance Sit, stand, walk, and bend for set periods of time; full range of motion 90 Degree Benefits, is an Equal Employment Opportunity (EEO) employer and does not discriminate on the basis of race, color, national origin, religion, gender, age, veteran status, political affiliation, sexual orientation, marital status, or disability (in compliance with the Americans with Disabilities Act) with respect to employment opportunities. Benefit Conditions: Waiting period may apply Only full-time employees eligible This Company Describes Its Culture as: Detail-oriented quality and precision-focused Aggressive competitive and growth-oriented Outcome-oriented results-focused with strong performance culture Stable traditional, stable, strong processes People-oriented supportive and fairness-focused Team-oriented cooperative and collaborative Relocation Assistance Provided: No Work Remotely: TBD Job Type: Full-time Pay: $33.00 - $37.00 per hour Expected hours: 40 per week Benefits 401(k) 401(k) matching Dental insurance Disability insurance Health insurance Life insurance Paid time off Vision insurance Schedule 8 hour shift Monday to Friday Education: Bachelor's (Required) Experience Case management: 2 years (Preferred) License/Certification: RN (Required) Certified Case Manager Certification (Preferred) - must obtain within 2 years.

Location: Charlotte, NC, US

Posted Date: 6/21/2025