A1A Case Manager RN - Registered Nurse - NC
Core
RN Case Manager assessing, planning, implementing, and coordinating case management activities with members to evaluate medical needs and facilitate overall wellness.
Role type
Senior IC Registered Nurse Case Manager
Builds
Integrated population health and customer service solutions for large plan sponsors
Domain
Health insurance / Population health management
Deliverable
client delivery
Required skills
Clinical judgment, case management processes, interviewing skills, claims review, multidisciplinary collaboration, regulatory compliance
Preferred skills
Certified Case Manager (CCM) certification, Oncology experience, Diabetes Care and Education Specialist, bilingual capabilities
Technologies
Microsoft Office 365, Teams, Outlook, EHR portals, VPN
Responsibilities
Develop proactive courses of action to enhance member wellness outcomes, conduct evaluations of member needs and benefit plan eligibility, apply clinical judgment to reduce risk factors and address complex health indicators, review prior claims to address impact on case management, consult with supervisors and present cases at conferences, utilize interviewing skills to discern health status and needs
Seniority
Mid-level, hands-on IC