Nurse Case Manager II
Core
Manage care for members with complex and chronic care needs by assessing needs, developing care plans, coordinating resources, and monitoring outcomes across the care continuum.
Role type
Senior Licensed Nurse Case Manager
Builds
Optimized member health care plans and care continuum management
Domain
Healthcare / Health Insurance
Required skills
Clinical assessment, Care plan development, Resource coordination, 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 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-Senior level, hands-on IC