Nurse Case Manager I
Core
Manage care plans for members with complex and chronic care needs by assessing, coordinating, and monitoring healthcare across the care continuum, including discharge planning.
Role type
Licensed RN Case Manager
Builds
Optimized member health outcomes and care continuity
Domain
Healthcare / Health Insurance
Required skills
RN licensure, care plan development, resource coordination, authorization/referral facilitation, provider negotiation, critical thinking
Preferred skills
Case management certification, utilization review experience, prior authorization experience, inpatient/outpatient clinical experience, Microsoft Office proficiency
Technologies
Microsoft Office
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; Negotiate reimbursement rates; Assist in problem-solving with providers and claims issues
Seniority
Mid-level, hands-on IC