Nurse Case Manager II
Core
Nurse Case Manager II responsible for care management for members with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, 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 / Insurance
Required skills
RN licensure, care plan development, care coordination, assessment, utilization management, provider negotiation, policy development
Preferred skills
Case Manager certification, Compact RN license
Technologies
Telephony, hospital systems
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 rates of reimbursement; Assist with development of utilization/care management policies and procedures.
Seniority
Mid-level, hands-on IC