Nurse Case Manager I
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
Nurse Case Manager
Builds
Care management plans and care coordination for health plan members
Domain
Healthcare / Health Insurance
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, care plan monitoring and evaluation
Preferred skills
Case Manager certification, Oncology experience
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