Telephonic Nurse Case Manager II
Core
Managing complex and chronic care needs for members via telephonic assessments, care plan development, and coordination of resources to optimize healthcare outcomes.
Role type
Licensed Registered Nurse (RN) Case Manager
Builds
Individualized care management plans and care continuum optimization
Domain
Healthcare / Managed Care
Deliverable
production ML models | product features | dashboards & analysis | research | client delivery | infrastructure | physical/clinical work
Required skills
RN licensure, care plan development, resource coordination, care assessment, care plan monitoring, utilization management, provider negotiation, policy development
Preferred skills
Case management certification, acute care experience, managed care experience, multitasking (talk and type), critical thinking, MS Office proficiency
Technologies
Microsoft Office
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; Interface with Medical Directors and Physician Advisors on treatment plans; Negotiate rates of reimbursement; Assist with development of utilization/care management policies
Seniority
Mid-level, hands-on IC