Nurse Case Mgr II
Core
Manage care plans for members with complex and chronic care needs by assessing, coordinating, and monitoring healthcare across the care continuum.
Role type
Licensed RN Case Manager
Builds
Care management plans and utilization policies
Domain
Healthcare / Health Insurance
Required skills
RN licensure, care plan development, resource coordination, authorization/referral facilitation, provider negotiation, policy development
Preferred skills
Case Manager certification, BS in health or human services
Technologies
None stated
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 on treatment plans; Negotiate rates of reimbursement; Assist with utilization/care management policies
Seniority
Mid-level, hands-on IC