Nurse Case Manager 1 100% Virtual, Carebridge
Core
Manage care for members with complex and chronic care needs by assessing needs, developing care plans, coordinating resources, and monitoring outcomes across the care continuum.
Role type
Licensed Nurse Case Manager (IC)
Builds
Individualized care management plans and care coordination for health plan members
Domain
Healthcare / Health 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 structure navigation, provider negotiation, discharge planning
Preferred skills
Case management certification, prior case management experience, home health experience
Responsibilities
Conduct assessments to identify individual needs and develop specific care management plans; Facilitate authorizations and referrals within benefits structures; 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; Negotiate rates of reimbursement with providers
Seniority
Individual Contributor, Mid-level (3+ years experience)