Nurse Case Manager II providing telephonic care management for members with complex care needs. Assessing and coordinating care plans while ensuring member access to appropriate services.
Responsibilities
Responsible for telephonic care management for members with complex and chronic care needs
Assessing, developing, implementing, coordinating, monitoring, and evaluating care plans
Conducting assessments to identify individual needs
Implementing care plan by facilitating authorizations/referrals as appropriate
Coordinating internal and external resources to meet identified needs
Monitoring and evaluating effectiveness of the care management plan
Negotiating rates of reimbursement as applicable
Assisting in problem solving with providers, claims, or service issues
Assisting with development of utilization/care management policies and procedures
Requirements
Requires 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
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