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 across the care continuum.
Role type
Licensed Nurse Case Manager
Builds
Care management plans and utilization policies
Domain
Healthcare / Insurance
Required skills
RN licensure, care plan development, resource coordination, provider negotiation, assessment, care plan monitoring
Preferred skills
Case Manager certification, prior Case Manager experience
Responsibilities
Conduct assessments to identify individual needs and develop care management plans; Facilitate authorizations and referrals within benefits structures; 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