Telephonic Nurse Case Manager II managing complex and chronic care needs for members. Assessing and coordinating care plans to optimize member health across a continuum of care in a virtual environment.
Responsibilities
Assessing, developing, implementing, coordinating, monitoring, and evaluating care plans
Conduct assessments to identify individual needs and specific care management plans
Implement care plan by facilitating authorizations/referrals
Coordinates internal and external resources to meet identified needs
Monitors and evaluates effectiveness of care management plan
Interfaces with Medical Directors and Physician Advisors on treatment plans
Assists in problem solving with providers, claims or service issues
Requirements
BA/BS in a health related field
Minimum of 5 years of clinical experience
Current, unrestricted RN license in applicable state(s)
Multi-state licensure is required if providing services in multiple states
Certification as a Case Manager is preferred
BS in a health or human services related field is preferred
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