Nurse Case Manager II
Core
Manage care for members with complex and chronic care needs by assessing, developing, implementing, coordinating, and evaluating care plans to optimize health outcomes across the care continuum.
Role type
Licensed RN Case Manager
Builds
Care management plans and utilization policies
Domain
Healthcare / Insurance
Deliverable
client delivery
Required skills
RN licensure, care plan development, resource coordination, benefit structure navigation, provider negotiation, policy development
Preferred skills
Case Manager certification, multi-state licensure
Technologies
Telephony, claims systems
Responsibilities
Conduct assessments to identify individual needs and specific care management plans; facilitate authorizations and referrals within benefits structures; coordinate internal and external resources; monitor and evaluate effectiveness of care plans; interface with Medical Directors and Physician Advisors; negotiate reimbursement rates; assist with utilization/care management policies.
Seniority
Mid-level individual contributor