Knowledge of health insurance industry trends, technology and contractual arrangements.
General computer skills (including use of Microsoft Office, Outlook, internet search). Familiarity with health care documentation systems.
Strong oral, written and interpersonal communication and customer service skills.
Ability to interpret policies and procedures, make decisions, and communicate complex topics effectively.
Strong organization and time management skills with the ability to manage workload independently.
Ability to think critically and make decision within individual role and responsibility.
Normally to be proficient in the competencies listed above:
Care Management Nurse would have a/an Associate or Bachelor’s Degree in Nursing or related field and 3 years of case management, utilization management, disease management, or behavioral health case management experience or equivalent combination of education and experience.
Required Licenses, Certifications, Registration, Etc.
Must have licensure or certification, in a state or territory of the United States, in a health or human services discipline that allows the professional to conduct an assessment independently as permitted within the scope of practice for the discipline (e.g. medical vs. behavioral health) and at least 3 years (or full time equivalent) of direct clinical care
Must have at least one of the following:
- Certification as a case manager from the URAC-approved list of certifications; or
- Bachelor’s degree (or higher) in a health or human services-related field (psychiatric RN or Master’s degree in Behavioral Health preferred for behavioral health care management); or
- Registered nurse (RN) license (must have a current unrestricted RN license for medical care management)