Nurse Case Mgr I (US)
Core
Manage care for members with complex and chronic care needs by assessing, developing, implementing, coordinating, and evaluating care plans to optimize health outcomes across the care continuum.
Role type
Licensed Nurse Case Manager
Builds
Care management plans and care coordination for health plan members
Domain
Healthcare / Health Insurance
Deliverable
client delivery
Required skills
RN licensure, care plan development, care coordination, benefit authorization, provider negotiation, discharge planning, care monitoring
Preferred skills
Case Manager certification, BS in health or human services
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 in problem solving with providers regarding claims or service issues