Nurse Case Mgr I (US)
Core
Manage care plans for members with complex and chronic care needs by assessing, coordinating, and monitoring healthcare across the care continuum.
Role type
Licensed RN Case Manager
Builds
Care management plans and care coordination for health plan members
Domain
Health insurance / Chronic care management
Required skills
RN licensure, care plan development, care coordination, authorization/referral facilitation, provider negotiation, claims/service issue resolution
Preferred skills
Case Manager certification, BS in health or human services
Technologies
Telephony, hospital systems
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; Interface with Medical Directors and Physician Advisors; Negotiate rates of reimbursement; Assist in problem solving with providers and claims issues
Seniority
Individual Contributor, Mid-level (3+ years experience)