Nurse Case Mgr II (US)
Core
Manage care for members with complex and chronic care needs by assessing needs, developing care plans, and coordinating resources to optimize health outcomes.
Role type
Licensed RN Case Manager
Builds
Individualized care management plans and care coordination for health plan members
Domain
Health Insurance / Chronic Care 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 authorization, provider communication, care plan evaluation
Preferred skills
Case Manager certification
Technologies
Telephony systems, benefits management platforms
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; Assist with development of utilization and care management policies.
Seniority
Mid-level Individual Contributor