OB/NICU/PEDs Nurse Case Manager I
Core
Case manager for members with complex and chronic care needs, assessing needs, developing care plans, and coordinating resources across the care continuum.
Role type
OB/NICU/PEDs Nurse Case Manager
Builds
Care management plans and service authorizations for health plan members
Domain
Healthcare insurance / Case management
Deliverable
client delivery
Required skills
Clinical assessment, care plan development, resource coordination, benefit structure navigation, provider negotiation, claims issue resolution
Preferred skills
Case Manager certification
Technologies
None stated
Responsibilities
Conduct assessments to identify individual needs and 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 and claims issues