Nurse Case Manager II
Core
Telephonic nurse case manager assessing, developing, implementing, coordinating, and evaluating care plans for members with complex and chronic care needs to optimize healthcare across the care continuum.
Role type
Licensed RN Case Manager
Builds
Care management plans and care continuum optimization
Domain
Healthcare / Insurance / Case Management
Deliverable
client delivery
Required skills
Clinical assessment, care plan development, care coordination, authorization/referral facilitation, provider negotiation, utilization review, policy development
Preferred skills
Case Manager certification, BS in health or human services
Technologies
None explicitly stated
Responsibilities
Conduct assessments to identify individual needs and develop specific 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 and modify as necessary; Interface with Medical Directors and Physician Advisors on treatment plans; Negotiate rates of reimbursement; Assist with development of utilization/care management policies and procedures
Seniority
Mid-level, hands-on IC