Job Summary
A company is looking for a Care Manager to oversee complex case management and care coordination for at-risk patient populations.
Key Responsibilities
- Conduct risk stratification and develop individualized care plans for complex patients
- Coordinate care and facilitate transitions for high-risk members, ensuring effective communication among all stakeholders
- Perform concurrent reviews and maintain electronic case management records while adhering to departmental standards
Required Qualifications
- High School Diploma or GED equivalent; BSN degree from an accredited university preferred
- Minimum of 2 years of case management experience in a managed care environment
- At least 1 year of experience in complex case management
- Knowledge of CMS and NCQA requirements for documentation and communication
- Licensure as a Registered Nurse (RN) required; Certified Case Manager (CCM) preferred
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