Nurse Case Manager I, 100% Virtual

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 and specific care management plans Facilitating authorizations/referrals as appropriate within benefits structure or through extra-contractual arrangements Coordinating internal and external resources to meet identified needs Monitoring and evaluating effectiveness of the care management plan and modifying as necessary Interfacing with Medical Directors and Physician Advisors on treatment plans 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) required Multi-state licensure is required if providing services in multiple states Certification as a Case Manager is preferred #J-18808-Ljbffr Jobtailor