Nurse Case Manager I
Core
Telephonic nurse case manager assessing, developing, implementing, coordinating, and evaluating care plans for members with complex and chronic care needs to optimize health across the care continuum.
Role type
Nurse Case Manager I
Builds
Care management plans and care continuum optimization
Domain
Healthcare / Insurance / Chronic Care Management
Deliverable
production ML models | product features | dashboards & analysis | research | client delivery | infrastructure | physical/clinical work
Required skills
RN licensure, care plan development, resource coordination, assessment, care plan monitoring, provider negotiation, discharge planning
Preferred skills
Case Manager certification, transplant experience
Technologies
None stated
Responsibilities
Conduct assessments to identify individual needs and develop specific care management plans; Facilitate authorizations and referrals within benefits structure; 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 and assist with provider/claims issues
Seniority
Individual Contributor, Entry to Mid-level