RN - Case Manager

Health Plan Care Manager

The Health Plan Care Manager is responsible for managing the development, implementation, and evaluation of care management service lines. This role aims to enhance the quality of member management by promoting continuity of care and cost-effectiveness through comprehensive in-patient and out-patient management, care integration, case management, utilization review, and care planning.

Key responsibilities include overseeing the development and execution of care management services to ensure effective member management, enhancing continuity of care and promoting cost-effective practices throughout the care continuum, integrating care management processes for both in-patient and out-patient settings, conducting ongoing evaluation and improvement of care management strategies, managing individual care plans and coordinating case management efforts to meet members' health needs, and performing utilization reviews to ensure appropriate use of healthcare services.

Qualifications include a current Registered Nurse (RN) license required, experience in care management, case management, or related field preferred, strong understanding of healthcare systems and care integration principles, excellent communication, organizational, and problem-solving skills, and the ability to work collaboratively with multidisciplinary teams.

Position available in multiple locations within the region, including City, State.