Ensures member access to services appropriate to their health needs
Conducts assessments to identify individual needs and specific care management plan
Implements care plan by facilitating authorizations/referrals as appropriate
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 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

Requires BA/BS in a health-related field
Minimum of 5 years of clinical experience
Current, unrestricted RN license in applicable state required
Multi-state licensure required for services in multiple states
Case Management experience preferred
Certification as a Case Manager preferred
Minimum 2 years’ experience in acute care setting preferred
Managed Care experience preferred
Ability to talk and type at the same time
Experience with Microsoft Office or ability to learn new computer programs/systems/software quickly
Ability to manage, review and respond to emails/instant messages in a timely fashion

Telephonic Nurse Case Manager II

Key skills