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Complex Case Manager Nurse

A Case Manager Nurse uses the nursing process to plan, implement, and evaluate the quality of patient care, and the use of resources. A primary focus is to monitor the quality of care in order to assure that there are appropriate levels of risk management. As a Complex Case Manager Nurse, you would also act as an advocate for patients and their families, and work with medical facilities such as hospitals and assisted living facilities. A Complex Case Manager Nurse facilitates the care of patients with complex issues such as mental health or substance abuse.

Job Duties

  • Acts as a primary source of care for patients with complex health needs, with a wide range of engagement
  • Conduct clinical assessments over the phone to address the health and wellness needs of patients using a set of clinical interviewing skills
  • Develop care plans based on patients specific needs by using the clinical information system to establish treatment goals
  • Communicates with the patients other care providers in more complex situations requiring case management intervention.
  • Serves as a subject matter expert to clinicians to provide education, consultation, and training when needed
  • Incorporates lifestyle improvement and prevention opportunities into member interactions

Education and Qualifications

  • Ability to work a flexible schedule
  • Current RN license is required
  • Generally, a Case Management Certification (CCM) is preferred
  • A Bachelor’s or Master’s in Nursing is also a preferred qualification
  • At least some experience working with the healthcare needs of a variety of people