Nurse Case Manager I managing complex care needs for members with a focus on optimal health outcomes. Role involves assessments, care plan coordination, and collaboration with medical professionals.
Responsibilities
Perform care management within the scope of licensure for complex and chronic care needs
Assess, develop, implement, coordinate, monitor, and evaluate care plans
Conduct assessments to identify individual needs
Implement care plans by facilitating authorizations/referrals
Monitor and evaluate effectiveness of care management plans
Interface with Medical Directors and Physician Advisors
Assist in problem solving with providers, claims or service issues
Requirements
Requires BA/BS in a health related field and minimum of 3 years of clinical experience
Current, unrestricted RN license in applicable state(s) required
Multi-state licensure is required if providing services in multiple states
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