• Responsible for the timely enrollment of the patient into the Patient Support Program • Collaborate with the patient, insurer, and physician regarding the documentation necessary for maximal reimbursement coverage, including the investigation of all public and private insurers and supporting employer escalations as required • Reviews the patient status and assists the prescribing physician to prepare documentation for public or private coverage by reviewing patient charts, assessing previous therapies and tests • Provides therapy guidelines/education on the program to manage patient and physician expectations • Collects information and conducts patient financial assessment eligibility based on program guidelines • Ensures patient services are coordinated and tracked in a timely manner resulting in quick and continued access to therapy • Reports Adverse Events/Severe Adverse Events (AE/SAEs) following approved SOPs • Maintain service levels in case management, including telephone answer rates, time to initiate contact with the patient, Adverse Events reported within twenty-four hours of receipt, and any other KPIs established as the Program level • Electronically updates the Customer Relationship Management (CRM) tool by providing timely patient and clinic information • Fosters and promotes a spirit of teamwork while working with internal patient support teams • Acts a liaison and provides ongoing feedback to the Program Manager based-on observations in the field and feedback from customers as it pertains to the quality of services, training, and other areas of importance • Identifies obstacles to obtaining coverage and channels this information to the Program Manager and/or Assistant Program Manager • Additional duties as requested by the Manager

Role Description The Case Manager Nurse plays a critical role in supporting members with complex or chronic conditions by providing proactive, telephonic case management grounded in a whole-person approach. This role focuses on reducing avoidable utilization, improving care coordination, and helping members navigate the healthcare system with confidence and clarity. As a trusted clinical resource, the Case Manager Nurse partners closely with members, providers, and health plans to assess needs, develop individualized care plans, and advocate for appropriate, cost-effective services. In addition to core case management responsibilities, this role also supports utilization review activities when needed, contributing to timely medical necessity determinations and continuity of care. This position is ideal for an experienced RN who brings strong clinical judgment, excellent communication skills, and a passion for improving outcomes for high-need populations in a collaborative, remote care management environment. This is a fully remote role. Candidates must reside in Iowa, Arizona, or Idaho. Schedule: This position works four 10-hour shifts per week and must be able to support ICM’s standard operating hours of 8:00 AM–5:00 PM Pacific Time. Specific shift times may vary based on business needs and the candidate’s time zone. What You'll Do - Patient Identification & Assessment - Identify members who would benefit from case management using claims data, referrals, and clinical records - Review referrals for clinical appropriateness using sound judgment and program parameters - Conduct comprehensive assessments of medical, behavioral, and social needs using a whole-person approach - Care Planning & Coordination - Develop individualized care plans based on patient needs, barriers, and goals - Coordinate care across the continuum, including primary care, specialists, behavioral health, and community-based resources - Facilitate clear communication between patients, providers, caregivers, and health plans to support safe transitions of care and adherence to treatment plans - Clinical Case Management & Advocacy - Provide telephonic case management for high-utilization patients with complex or chronic conditions - Use best practices in chronic disease management, motivational interviewing, and patient education - Advocate for timely, appropriate, and cost-effective care while balancing clinical judgment with plan guidelines - Support patients in navigating healthcare systems and overcoming barriers to care - Utilization Review & Medical Decision-Making - Evaluate precertification requests using evidence-based criteria and plan-specific guidelines - Review ongoing inpatient stays and make length-of-stay determinations as appropriate - Partner with Appeals & Denials and/or in-house providers to support complex clinical decisions - Documentation, Reporting & Compliance - Document all assessments, interventions, communications, and determinations thoroughly and accurately in ICM systems - Provide client-facing reports summarizing interventions, outcomes, and estimated cost savings - Ensure compliance with internal policies, regulatory requirements, and HIPAA standards - Collaboration, Leadership & Continuous Improvement - Partner with other clinical teams across ICM to remove care barriers and improve patient outcomes - Serve as a senior clinical resource, contributing to program development, cross-training, and process improvement - Stay current on best practices, regulations, and clinical guidelines related to case management - Participate in training, quality assurance initiatives, and professional development Qualifications - Active, unrestricted Registered Nurse (RN) license in good standing - Associate’s or Bachelor’s degree in Nursing - 5+ years of clinical nursing experience - OB, maternity, labor and delivery, postpartum, maternal-child health, or related nursing experience - Strong knowledge of chronic disease management, utilization management, and social determinants of health - Experience managing complex, high-utilization patient populations - Excellent written and verbal communication skills with empathy, professionalism, and emotional intelligence - Strong organizational skills with the ability to manage multiple priorities independently - Sound clinical judgment and confidence navigating complex or sensitive situations - Comfort working independently in a remote environment with strong accountability and follow-through - Ability to manage confidential information in compliance with HIPAA - Must reside in Iowa, Arizona, or Idaho - Ability to work four 10-hour shifts per week and support coverage during ICM’s standard operating hours of 8:00 AM–5:00 PM Pacific Time Even Better If You Have - Case management or utilization certifications (e.g., CCM, CPUR, CPHM) - Experience with maternity case management, high-risk pregnancy care coordination, or perinatal care management - Experience in case management - Experience in a TPA or self-funded health plan environment - Knowledge of health insurance regulations and utilization management processes - Experience using medical necessity criteria and utilization review tools - Experience with EMRs and care management platforms - Multi-state licensure

Title: Nursing Home Transition Service Coordinator Location: PA, United States Remote Full-time Regular Requisition ID: 11127 Job Description: Service Coordinator, Nursing Home Transition (NHT) All Abilities, Inc. has a long-standing history of providing service to those in need. With original roots in Southwestern Pennsylvania, All Abilities has expanded to provide service coordination to people across the Commonwealth of Pennsylvania. All Abilities is committed to assuring those served live life to the fullest by coordinating necessary services that allow them to remain in their home and community while becoming as independent as possible. All Abilities, Inc., a subsidiary of Lifesteps, is seeking a full-time Nursing Home Transition Service Coordinator to work in or near the Hazelton, PA area. The Nursing Home Transition Service Coordinator (NHTSC) supports program Participants by helping to determine their individualized needs and receiving appropriate support to transition from a nursing facility back into the community. The NHTSC adheres to state and federal laws/regulations along with contractual obligations set forth by the contracted Health Plans/Managed Care Organization(s). Job duties may include: Assist the participant with finding housing options, utility service options, coordinate with the nursing home staff and participant family members as needed, check on any waiver or income funding, etc. The NHTSC may conduct case management in Luzurne, Lackawanna, Carbon, Schuylkill, or Northumberland Counties. QUALIFICATIONS: Required: - High School Diploma or GED - Demonstrated ability to communicate and provide excellent customer service - Demonstrated ability to organize multiple tasks in a timely manner - Ability to travel throughout assigned area up to 50% per week (travel within 50 miles of Hazelton, PA) using a personal vehicle - mileage reimbursement available - Proficient with Microsoft Office Suite, Outlook and Adobe PDF - Current driver's license and the ability to travel for business utilizing personal vehicle - Ability to obtain ACT 33/34 and FBI clearances required - Ability to work from home remotely with a dependable internet connection Preferred: - Associates degree or higher in social work, sociology, social welfare, psychology, gerontology or related behavioral science - Three (3) years' experience in a social service or healthcare setting - Experience with local housing markets and developing relationships with Providers - Prior experience in providing Nursing Home Transition services - Bi-lingual or Multilingual Competitive benefit package includes 100% paid medical, dental and vision insurance premiums; Paid time off, plus 8 paid holidays.

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