Registered Nurse / Case Manager (WTCHP)

Description: About BeVera Solutions, LLC: BeVera Solutions, LLC is a rapidly growing public health and professional services company that provides innovative solutions to federal and state agencies. Our team supports mission-critical programs through expertise in program management, communications, acquisition, data analytics, and public health initiatives. Recognized as one of Atlanta’s Best Places to Work (2024 & 2025) by the Atlanta Business Chronicle, BeVera fosters a culture of integrity, excellence, and collaboration. Job Summary: BeVera Solutions, LLC is seeking a full-time, detail-oriented, and compassionate Registered Nurse / Case Manager to support member-centered health services through comprehensive care coordination, utilization support, and member advocacy. The Case Manager will assess member needs, coordinate clinical and non-clinical services, and facilitate communication across providers and program stakeholders to ensure timely access to care, continuity of services, and compliance with program requirements. NOTICE – CONTINGENT POSITION: This role is part of a pre-award candidate search for an upcoming federal government contract. Key Responsibilities Member Care Coordination • Provide individualized case management services tailored to each member’s clinical, social, and administrative needs. • Coordinate medical monitoring, diagnostic services, and treatment for members receiving care through the Nationwide Provider Network (NPN). • Assist members in navigating the WTCHP care continuum, including understanding benefits, treatment pathways, and required documentation. • Support continuity of care by coordinating among NPN providers, the Third-Party Administrator (TPA), Pharmacy Benefits Manager (PBM), and WTCHP Program staff. Clinical and Non-Clinical Case Management • Deliver both standard and intensive case management services in accordance with WTCHP Case Management and Utilization Management Standard Operating Procedures. • Identify barriers to care such as geographic access, provider availability, coordination of benefits, or member adherence, and implement strategies to mitigate those barriers. • Promote efficiency and appropriate utilization of services while supporting high member satisfaction and positive health outcomes. • Encourage and support member self-management of care over time, as clinically appropriate. Utilization and Authorization Support • Collaborate with NPA utilization management staff to support prior authorization processes related to certified WTC-related conditions. • Review clinical documentation and supporting information to ensure services align with Program coverage requirements. • Monitor trends in utilization and member needs and communicate emerging issues to leadership to inform program improvements. Member Advocacy and Issue Resolution • Serve as an advocate for members by addressing concerns, resolving care coordination issues, and facilitating communication among stakeholders. • Assist members in understanding Program policies, rights, responsibilities, and appeals processes. • Support outreach efforts to re-engage inactive or hard-to-reach members. Documentation and Data Management • Maintain accurate, timely, and compliant case records within the NPA’s secure data and document management systems. • Ensure documentation complies with HIPAA, WTCHP privacy requirements, and National Archives and Records Administration (NARA) digitization standards. • Participate in bidirectional data exchanges with WTCHP and other Program contractors to ensure consistency and accuracy of member information. Quality Management and Continuous Improvement • Participate in quality assurance activities, audits, and performance monitoring initiatives. • Contribute to continuous improvement efforts by identifying trends, systemic issues, and opportunities to enhance member experience and care coordination. • Complete required training and maintain up-to-date knowledge of WTCHP policies, procedures, and evolving Program requirements. Requirements: Educational and Experience Qualifications The following qualifications are the minimum requirements for successful performance under the anticipated contract. • Minimum Education: Bachelor’s degree in Nursing, Social Work, Public Health, Health Administration, or a related field (Master’s degree preferred). • Minimum of 4–5 years of clinical experience • Minimum 3 years of experience in healthcare case management, care coordination, or utilization management. • Must be a licensed Registered Nurse (RN) • Must possess active clinical licensure (e.g., RN, LCSW, LMSW, or equivalent) • Multi-State (NLC) RN licensure preferred • Demonstrated experience working with complex medical populations, chronic conditions, or federally funded health programs. • Strong knowledge of healthcare delivery systems, referral networks, and benefits coordination. • Experience working with geographically dispersed populations and telephonic or remote case management. • Ability and willingness to travel as required for program needs. • Experience with Microsoft Office programs • Must be able to implement critical thinking and decision making skills in order to identify appropriate care/treatment plans for a wide range of members from low to high complexity Preferred Experience: • Experience supporting federal health programs or government-funded benefit programs. • Familiarity with utilization management, prior authorization processes, and medical necessity determinations. • Experience working in multidisciplinary environments involving providers, administrators, and government stakeholders. • Cultural competency and experience communicating with diverse populations on sensitive health-related topics. Key Skills and Competencies: • Strong interpersonal, communication, and member-engagement skills. • Ability to manage complex cases with empathy, professionalism, and attention to detail. • Excellent organizational and documentation skills. • Proficiency with electronic case management systems and secure data platforms. • Ability to work independently while collaborating effectively within a team-based environment. Additional information All information will be kept confidential according to EEO guidelines. Equal Employment Opportunity Statement BeVera Solutions is an Equal Opportunity Employer. Employment decisions are made solely on the basis of merit, qualifications, and business needs. We prohibit discrimination against any applicant or employee based on race, color, religion, sex, national origin, age, United States military veteran status, ancestry, marital status, family structure, medical condition (including genetic information), disability, or any other status protected under applicable federal, state, or local law, provided the essential functions of the job can be performed with or without reasonable accommodation. BeVera complies with all applicable federal, state, and local equal employment opportunity laws and maintains a strictly merit-based hiring process consistent with current federal contracting requirements. Apply tot his job Apply To this Job