Nurse Case Manager II CA
Core
Telephonic care management for members with complex and chronic care needs, assessing needs and coordinating care plans across the care continuum.
Role type
Licensed RN Case Manager
Builds
Optimized member health care outcomes through care plan implementation and resource coordination
Domain
Healthcare / Managed Care
Deliverable
client delivery
Required skills
RN licensure, care plan development, care coordination, benefits structure navigation, provider negotiation, utilization review, critical thinking
Preferred skills
Case management certification, acute care experience, managed care experience, multi-state licensure, simultaneous talking and typing
Technologies
Microsoft Office, care management systems
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 in problem solving with providers and claims issues
Seniority
Mid-level individual contributor