Nurse Case Mgr II (US)
Core
Care management for members with complex and chronic care needs by assessing, developing, implementing, coordinating, and evaluating care plans to optimize health care across the care continuum.
Role type
Licensed RN Case Manager
Builds
Care management plans and authorizations/referrals
Domain
Health insurance / Chronic care management
Required skills
RN licensure, care plan development, care coordination, utilization management, provider communication, policy development
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; Interface with Medical Directors and Physician Advisors on treatment plans; Assist with development of utilization/care management policies and procedures.