• Ensures member access to services appropriate to their health needs
• Conducts assessments to identify individual needs
• Develops specific care management plan
• Implements care plan by facilitating authorizations/referrals
• Coordinates internal and external resources to meet needs
• Monitors and evaluates effectiveness of care management plan

Requirements

Requires a BA/BS in a health-related field
5 years of clinical experience
Current, unrestricted RN license in applicable state(s)
Multi-state licensure required if providing services in multiple states
Strong clinical background in an acute care hospital setting preferred
Prior telephonic Case Management experience with a Managed Care Company preferred
Certification as a Case Manager preferred
Ability to talk and type at the same time
Strong critical thinking skills
Experience with Microsoft Office and ability to learn new computer programs

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Hard Skills

clinical experience
care management plan development
telephonic case management
authorizations
referrals
assessment
monitoring and evaluation

Soft Skills

critical thinking
communication
coordination

Certifications & Qualifications

RN license
Case Manager certification

Telephonic Nurse Case Manager II

Manager, Private Markets Implementations, Consulting

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Clinical Care Manager, Nurse

Care Coordinator, Case Manager – Dual Eligible Special Needs Plan