Nurse Case Manager Lead
Core
Telephonic lead for care management of members with complex and chronic care needs, assessing needs and optimizing healthcare across the care continuum.
Role type
Senior IC licensed nurse case manager lead
Builds
Care management plans and utilization policies for health plan members
Domain
US Healthcare / Managed Care
Deliverable
client delivery
Required skills
RN licensure, care plan development, authorization/referral facilitation, provider negotiation, policy development, audit activities, staff precepting
Preferred skills
Case manager certification, managed care experience, disease process knowledge
Technologies
None stated
Responsibilities
Conduct assessments to identify individual needs and develop care management plans; Implement care plans by facilitating authorizations and referrals; Coordinate internal and external resources to meet identified needs; Monitor and evaluate effectiveness of care management plans; Interface with Medical Directors and Physician Advisors on treatment plans; Negotiate rates of reimbursement; Assist with development of utilization/care management policies and procedures; Participate in audit activities and manage day-to-day activities including workflow monitoring and coaching
Seniority
Senior, hands-on IC with leadership responsibilities