Ensures member access to services appropriate to their health needs
Conducts assessments to identify individual needs and specific care management plans
Implements care plans by facilitating authorizations/referrals within benefits structure
Coordinates internal and external resources to meet identified needs
Monitors and evaluates effectiveness of care management plans and modifies as necessary
Interfaces with Medical Directors and Physician Advisors on care management treatment plans
Assists in problem solving with providers, claims or service issues
Assists with the development of utilization/care management policies and procedures

Requires a BA/BS in a health-related field
3 years of clinical experience
Current, unrestricted RN license from the State of Georgia required
Multistate licensure is required if providing services in multiple states
Ability to talk and type at the same time
Certification as a Case Manager (preferred)
Demonstrates critical thinking skills when interacting with members
Experience with Microsoft Office and/or ability to learn new computer programs/systems/software quickly
Ability to manage, review and respond to emails/instant messages in a timely fashion

Nurse Case Manager I

Key skills