Nurse Case Mgr I
Core
A licensed nurse responsible for care management of members with complex and chronic care needs, assessing needs, developing care plans, and coordinating resources across the care continuum.
Role type
Licensed Nurse Case Manager
Builds
Optimized member health care plans and coordinated service access
Domain
Healthcare / Insurance / Chronic Care Management
Required skills
RN licensure, care plan development, care coordination, benefit authorization, provider negotiation, discharge planning, care monitoring
Preferred skills
Case Manager certification, health or human services degree
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; Negotiate rates of reimbursement; Assist in problem solving with providers regarding claims or service issues