RN Case Manager: Complex Care & Care Coordination

Avera Health Plans Inc; Sioux Falls (SD); Presencial; USD 43.000 - 64.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

PTO from day 1

5% employer retirement matching

Career development mentorship

Equal Opportunity Employer

Descripción de la vacante

Avera Health Plans is seeking an RN Case Manager to identify and coordinate care for members with complex or chronic conditions in a multidisciplinary team. You will develop individualized care plans and collaborate with physicians, care coordinators, and health system partners to achieve optimal, cost-effective outcomes.

Responsibilities include utilization management, preauthorizations, and end-to-end transplant member management, with a focus on NCQA standards.

Formación

• Active RN license in the state of practice.
• CCM certification within 3 years or CMCN certification within 3 years.
• Experience in acute care settings preferred.

Responsabilidades

• Identifies cases that qualify for complex/chronic condition case management and/or service coordination.
• Creates and executes care plans for chronic/complex members with NCQA standards in mind.
• Performs utilization management activities including preauthorizations, inpatient reviews, and post-review decisions.
• Manages all transplant member needs end-to-end across pre, intra, and post phases.
• Communicates with departments and educates stakeholders on benefit plan design and claims processing.

Conocimientos

Case management

Utilization management

Care coordination

Patient advocacy

Interdisciplinary collaboration

Educación

Registered Nurse (RN) license

Certified Case Manager (CCM)

Certified Managed Care Nurse (CMCN)

Descripción del empleo

Avera Health Plans is seeking an RN Case Manager to identify and coordinate care for members with complex or chronic conditions in a multidisciplinary team. You will develop individualized care plans and collaborate with physicians, care coordinators, and health system partners to achieve optimal, cost-effective outcomes.

Responsibilities include utilization management, preauthorizations, and end-to-end transplant member management, with a focus on NCQA standards.