Nurse Case Manager I

Responsibilities 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 Requirements 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 Core Competencies Demonstrates expertise in care management, including conducting assessments, implementing care plans, and coordinating resources to meet health needs. Proficient in critical thinking and problem‑solving within clinical settings, with a strong focus on member access and service effectiveness. #J-18808-Ljbffr Jobtailor