Transplant Nurse II
Core
Provides case and medical management for members receiving transplant services, assessing needs, developing care plans, and ensuring cost-effective, medically appropriate care.
Role type
Licensed nurse (case and medical management)
Builds
Care management plans and utilization review decisions
Domain
Healthcare / Health Insurance / Managed Care
Deliverable
dashboards & analysis
Required skills
Nursing licensure, care plan development, utilization review, benefits interpretation, provider coordination, regulatory compliance
Preferred skills
Care management certification, multi-state licensure, medical management process knowledge, health insurance knowledge
Responsibilities
Conduct assessments to identify individual needs and develop 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 plans; Conduct pre-certification, retrospective, and appropriateness reviews; Consult with clinical reviewers and medical directors; Facilitate member care transitions and discharge planning.
Seniority
Mid-level IC