Nurse Care Manager I
Core
Collaborate with healthcare providers and consumers to drive personalized health management and improve health outcomes for members with complex and chronic care needs.
Role type
Nurse Care Manager I
Builds
Medically appropriate, high quality, cost effective care plans and interventions
Domain
Healthcare / Health Insurance / Chronic Care Management
Deliverable
production ML models | product features | dashboards & analysis | research | client delivery | infrastructure | physical/clinical work
Required skills
Acute care clinical experience, Clinical assessment, Care plan development, Discharge planning, Medical necessity assessment, Care plan monitoring
Preferred skills
Home health experience, Case Manager certification, Critical care background (ICU, Emergency, Med Surg), Bachelor's in Nursing
Technologies
Electronic Health Records (EHR), Care Management Platforms
Responsibilities
Assess medical necessity of inpatient admissions and extensions of stay, Partner with physician clinical reviewers to interpret appropriateness of care, Collaborate with providers to plan for discharge, Conduct clinical assessments to develop individualized care goals, Monitor and evaluate effectiveness of care management plans, Modify care plans as necessary based on consumer needs
Seniority
Individual Contributor, Mid-level