Telephonic Nurse Case Manager I handling care management for members with complex healthcare needs. Role involves assessments, care plan evaluations, and coordination of resources across multiple states.
Responsibilities
performing care management within the scope of licensure for members with complex and chronic care needs
assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care
conducting assessments to identify individual needs
facilitating authorizations/referrals as appropriate
coordinating internal and external resources to meet identified needs
monitoring and evaluating effectiveness of the care management plan
interfacing with Medical Directors and Physician Advisors on development of care management treatment plans
negotiating rates of reimbursement as applicable
assisting in problem solving with providers, claims or service issues
Requirements
BA/BS in a health-related field
minimum of 3 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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