Nurse Case Manager I
Core
Nurse Case Manager I responsible for care management of members with complex and chronic care needs by assessing, developing, implementing, coordinating, and evaluating care plans to optimize healthcare across the care continuum.
Role type
Licensed Nurse Case Manager
Builds
Care management plans and care continuum optimization
Domain
Healthcare / Health Insurance
Required skills
Care plan development, Care coordination, Benefit authorization, Provider communication, Clinical assessment, Care monitoring
Preferred skills
Case Manager certification, Compact RN license
Technologies
Telephonic communication tools
Responsibilities
Conduct assessments to identify individual needs and develop specific care management plans, Facilitate authorizations and referrals within benefits structure, Coordinate internal and external resources to meet identified needs, Monitor and evaluate effectiveness of care management plans and modify as necessary, Interface with Medical Directors and Physician Advisors on treatment plans, Assist in problem solving with providers regarding claims or service issues
Seniority
Mid-level, Individual Contributor