Assess health management needs of assigned member panel
Utilize data/analytics in conjunction with professional clinical judgement to identify the right clinical intervention for each member
Manage an active case load of members in case management
Conduct outreach to members enrolled in case management including developing a care plan, encouraging behavior changes, coordinating care, and identifying resources
Monitor, improve and maintain quality outcomes for the specified panel of members

High School Diploma/GED required
7 years of any combination of clinical, case management and/or disease/condition management experience, provider operations and / or health insurance experience required
Current State of PA RN licensure OR Current multi-state licensure through the enhanced Nurse Licensure Compact (eNLC) or WV or DE or NY required
Certification in Case Management preferred
Advanced training and experience in cognitive behavioral therapy (CBT), motivational interviewing or dialectical behavior therapy (DBT) preferred

Complex Case Manager, RN

Key skills