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 care across the continuum.
Role type
Licensed RN Case Manager
Builds
Care management plans and utilization policies
Domain
Health Insurance / Care Management
Required skills
RN licensure, care plan development, care coordination, benefit authorization, provider communication, policy development
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 management plans; Interface with Medical Directors and Physician Advisors on treatment plans; Assist with development of utilization/care management policies and procedures.