Nurse Case Manager I
Core
Telephonic care management for members with complex and chronic care needs, assessing needs and coordinating care plans across the care continuum.
Role type
Nurse Case Manager
Builds
Optimized member health care plans and coordinated service access
Domain
Health Insurance / Chronic Care Management
Deliverable
client delivery
Required skills
RN licensure, care plan development, resource coordination, benefits structure navigation, provider interface, care plan evaluation
Preferred skills
Medicare/Medicaid program experience, prior nurse case management experience
Responsibilities
Conduct assessments to identify individual needs, implement care plans by facilitating authorizations/referrals, coordinate internal and external resources, monitor and evaluate care plan effectiveness, interface with Medical Directors and Physician Advisors, assist in problem solving with providers or claims issues
Seniority
Individual Contributor, 3+ years clinical experience