Nurse Case Manager I
Core
Manage care plans for members with complex and chronic care needs by assessing, coordinating, and monitoring healthcare across the care continuum, including discharge planning and hospital interfaces.
Role type
Nurse Case Manager
Builds
Optimized member health outcomes and care continuity
Domain
Healthcare / Insurance / Case Management
Deliverable
production ML models | product features | dashboards & analysis | research | client delivery | infrastructure | physical/clinical work
Required skills
RN licensure, care plan development, resource coordination, benefit authorization, provider negotiation, claims resolution, clinical assessment
Preferred skills
Case management certification, behavioral health experience, intellectual/developmental disabilities experience, home health experience, utilization management, hospital discharge planning
Technologies
EHR systems, claims management platforms, telephony
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; Negotiate rates of reimbursement; Assist in problem solving with providers and claims issues
Seniority
Individual Contributor, Mid-level (3+ years experience)