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.
Role type
Nurse Case Manager
Builds
Care management plans and care coordination for health plan members
Domain
Health insurance / Case management
Deliverable
client delivery
Required skills
RN licensure, care plan development, care coordination, benefit authorization, provider negotiation, discharge planning
Preferred skills
Case Manager certification, MCO or hospital case management experience, telephonic case management experience
Responsibilities
Conduct assessments to identify individual needs and develop 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
Individual Contributor, Mid-level