RN, HEALTH PLAN CARE MANAGER

Job Summary:

Manages the development, implementation, and evaluation of care management services. Promotes continuity of care, cost effectiveness, care integration, case management, utilization review, and care planning.

Education & Experience:

Bachelor's Degree in Nursing (BSN) (Preferred) Nursing experience (Preferred)

Licenses & Certifications:

Registered Nurse (RN) licensure in state of practice (Required) Certified Case Manager (CCM) (Preferred)

Key Responsibilities:

Coordinates care management services for Health Plan members. Partners with physicians, claims, and data management teams to support member care. Coordinates preventative care, wellness, and nutritional counseling. Collaborates on quality improvement, resource utilization, and cost reduction initiatives. Reviews member conditions for medical necessity criteria. Manages discharge planning and utilization management communication. Maintains positive relationships with internal and external customers. Performs other job-related duties as assigned. #Workwolf