Case Manager Registered Nurse - Two Rivers Region KY
Core
A field-based Registered Nurse Case Manager who assesses, plans, and coordinates care for members to improve health outcomes and manage complex medical and psychosocial needs.
Role type
Senior IC Registered Nurse Case Manager
Builds
Member care plans and coordinated care strategies for health plan members
Domain
Health Insurance / Managed Care / Behavioral Health
Deliverable
production ML models | product features | dashboards & analysis | research | client delivery | infrastructure | physical/clinical work
Required skills
Clinical assessment, care coordination, motivational interviewing, claims review, care plan development, regulatory compliance, multidisciplinary consultation, functional capacity evaluation
Preferred skills
Foster care knowledge, trauma-informed care, discharge planning, managed care utilization review, developmental milestones expertise, complex medical condition management
Technologies
MS Office Suite, Teams, Outlook, Word, Excel, clinical assessment tools
Responsibilities
Conduct comprehensive clinical evaluations of member needs and benefit eligibility; create and monitor member care plans; consult with supervisors and care partners to resolve barriers; present cases at multidisciplinary conferences; utilize motivational interviewing to engage members; review prior claims for impact on current management.
Seniority
Senior, hands-on IC
