Telephonic Nurse Case Manager I
Core
A licensed nurse providing telephonic care management for members with complex and chronic care needs, assessing needs, developing care plans, and coordinating resources to optimize health outcomes.
Role type
Licensed RN Case Manager (Telephonic)
Builds
Individualized care management plans and care coordination for health plan members
Domain
Health Insurance / Managed Care
Deliverable
production ML models | product features | dashboards & analysis | research | client delivery | infrastructure | physical/clinical work
Required skills
Clinical assessment, care plan development, care coordination, authorization/referral facilitation, provider negotiation, claims/service issue resolution, multi-state licensure
Preferred skills
Case Manager certification
Technologies
None stated
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 and modify as necessary; 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
Seniority
Individual Contributor, Mid-Level (3+ years experience)