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
Optimized member health outcomes and care continuity
Domain
Healthcare / Insurance / Case Management
Required skills
RN licensure, care plan development, care coordination, benefit authorization, provider negotiation, claims resolution, discharge planning
Preferred skills
Case Manager certification, BS in health or human services
Technologies
EHR systems, benefits management platforms
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 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