Maternal Child Nurse Case Manager I
Core
A licensed nurse case manager who assesses, develops, implements, and monitors care plans for members with complex and chronic care needs, optimizing healthcare across the care continuum.
Role type
Maternal Child Nurse Case Manager I
Builds
Care management plans and care coordination for health plan members
Domain
Healthcare / Health Insurance / Case Management
Deliverable
client delivery
Required skills
RN licensure, care plan development, care coordination, benefits structure navigation, provider negotiation, discharge planning, care plan evaluation
Preferred skills
NICU experience, Case Manager certification
Technologies
None explicitly stated
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 and modify as necessary; Interface with Medical Directors and Physician Advisors on treatment plans; Negotiate rates of reimbursement; Assist in problem solving with providers regarding claims or service issues
Seniority
Individual Contributor, 3+ years experience