Outsource Manager in Customer Experience department managing vendor relationships and ensuring service quality. Collaborating cross - functionally to optimize customer interaction processes while balancing efficiency.
About the role
- Telephonic Nurse Case Manager II ensuring member access to health services through assessments and care management plans. Responsible for coordinating resources and evaluating care effectiveness.
Responsibilities
- Ensures member access to services appropriate to their health needs
- Conducts assessments to identify individual needs and a specific care management plan to address objectives and goals as identified during assessment
- Implements care plan by facilitating authorizations/referrals as appropriate within benefits structure or through extra-contractual arrangements
- Coordinates internal and external resources to meet identified needs
- Monitors and evaluates effectiveness of the care management plan and modifies as necessary
- Interfaces with Medical Directors and Physician Advisors on the development of care management treatment plans
- Negotiates rates of reimbursement, as applicable
- Assists in problem solving with providers, claims or service issues
- Assists with development of utilization/care management policies and procedures
Requirements
- Requires BA/BS in a health related field and minimum of 5 years of clinical experience
- Current, unrestricted RN license in applicable state(s) required
- Multi-state licensure is required if this individual is providing services in multiple states
- Certification as a Case Manager is preferred
- BS in a health or human services-related field is preferred
- OB experience is strongly preferred
- NICU experience is a plus
Benefits
- Comprehensive benefits package
- Incentive and recognition programs
- Equity stock purchase
- 401k contribution
Job title
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Experience level
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Degree requirement
Location requirements
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