Clever Care Health Plan

Perform clinical reviews of authorization requests to determine medical necessity based on established criteria and regulatory requirements. Communicate decisions to providers and members while ensuring compliance with CMS and state turnaround times.

The Case Manager II - RN manages a caseload of moderately to highly complex members, serving as a clinical resource for Case Manager I staff. Responsibilities include conducting comprehensive assessments, developing individualized care plans, coordinating medical and behavioral health services, and leading interdisciplinary care team conferences.