Nurse Case Manager II
Core
Manage care for members with complex and chronic care needs by assessing, developing, implementing, coordinating, and evaluating care plans to optimize health outcomes across the care continuum.
Role type
Licensed Nurse Case Manager
Builds
Care management plans and utilization policies
Domain
Health insurance / Managed care
Deliverable
production ML models | product features | dashboards & analysis | research | client delivery | infrastructure | physical/clinical work
Required skills
RN licensure, care plan development, care coordination, benefit authorization, provider negotiation, policy development
Preferred skills
Case Manager certification, multi-state licensure, case management experience
Technologies
Telephony, benefits systems
Responsibilities
Conduct assessments to identify individual needs and develop specific care management plans; Facilitate authorizations and referrals within the benefits structure; Coordinate internal and external resources to meet identified needs; Monitor and evaluate the effectiveness of care management plans; Interface with Medical Directors and Physician Advisors on treatment plans; Negotiate reimbursement rates with providers.
Seniority
Mid-level, hands-on IC