Lead Nurse Case Manager

Responsibilities

• Telephonic Nurse Case Manager Lead responsible for care management within the scope of licensure for members with complex and chronic care needs.
• Conducts assessments to identify individual needs and a specific care management plan to address objectives and goals.
• Implements care plan by facilitating authorizations/referrals.
• Coordinates internal and external resources to meet identified needs.
• Monitors and evaluates effectiveness of the care management plan and modifies as necessary.
• Interfaces with Medical Directors and Physician Advisors.
• Assists in problem solving with providers, claims or service issues.
• Participates in audit activities and assists supervisor with management of day-to-day activities.

• Requires a BA/BS in a health related field and 5 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.
• Current, unrestricted RN license in applicable state(s) required.
• Case manager certification required within 3 years of starting in this role.
• Certification as a Case Manager is preferred.
• BS in a health or human services related field preferred.
• Managed care experience necessary.
• Case management experience a plus.