Nurse Case Manager II - California
Core
Manage care for members with complex and chronic care needs by assessing, developing, implementing, coordinating, and evaluating care plans to optimize health across the care continuum.
Role type
Licensed RN Case Manager
Builds
Care management plans and utilization policies
Domain
Healthcare / Insurance
Required skills
Clinical assessment, care plan development, authorization/referral facilitation, resource coordination, provider negotiation, policy development
Preferred skills
Case Manager certification, BS in health or human services
Technologies
Telephony, hospital systems
Responsibilities
Conduct assessments to identify individual needs and 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 on treatment plans; Negotiate rates of reimbursement; Assist with development of utilization/care management policies.
Seniority
Mid-level, hands-on IC