Nurse Case Mgr I (RN)
Core
Manage care plans for members with complex and chronic care needs by assessing needs, coordinating resources, and monitoring health outcomes via telephone.
Role type
Licensed Registered Nurse Case Manager
Builds
Optimized care plans and coordinated service access for health plan members
Domain
Healthcare / Insurance / Case Management
Required skills
RN licensure, care plan development, resource coordination, telephonic communication, benefits structure navigation, medical director liaison
Preferred skills
Case management certification, home health experience, utilization management, hospital discharge planning
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; Assist in problem solving with providers regarding claims or service issues