Nurse Case Manager I
Core
A licensed nurse responsible for assessing, developing, implementing, and monitoring care plans for members with complex and chronic care needs to optimize healthcare across the care continuum.
Role type
Nurse Case Manager
Builds
Care management treatment plans and coordinated service access for health plan members
Domain
Health Insurance / Case Management
Deliverable
production ML models | product features | dashboards & analysis | research | client delivery | infrastructure | physical/clinical work
Required skills
Clinical assessment, care plan development, authorization facilitation, resource coordination, provider interface, precepting
Preferred skills
Case management experience, home health experience, utilization management, hospital discharge planning
Technologies
Telephony, benefits structure systems
Responsibilities
Conduct assessments to identify individual needs and 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 plans and modify as necessary; Interface with Medical Directors and Physician Advisors on treatment plans; Assist in problem solving with providers and claims issues; Function as preceptor for new care management staff
Seniority
Individual Contributor, Mid-level (3+ years experience)