Large Case Manager RN

Lucent Health Solutions LLC•Nashville, TN

8h•Hybrid

About The Position

Lucent Health combines top-tier claims management with a compassionate, human-focused, data-driven care management solution. This approach helps self-insured employers provide care management that enables health plan participants to make smarter, cost-saving healthcare decisions. Continuous data analytics offer ongoing insights, ensuring participants receive the right care, at the right cost, at the right time. Join us as we build a company that aims to be a better health benefits partner for self-insured employers. We believe that the success of Lucent Health relies on having employees who are honest, ethical and hardworking. These values are the foundation of Lucent Health. Honest Transparent Communication: be open and clear in all interactions without withholding crucial information Integrity: ensure accuracy in reporting, work outputs and any tasks assigned Truthfulness: provide honest feedback and report any issues or challenges as they arise Trustworthiness: build and maintain trust by consistently demonstrating reliable behavior Ethical Fair Decision Making: ensure all actions and decisions respect company policies and values Accountability: own up to mistakes and take responsibility for rectifying them Respect: treat colleagues, clients and partners with fairness and dignity Confidentiality: safeguard sensitive information and avoid conflicts of interest Hardworking Consistency: meet or exceed deadlines, maintaining high productivity levels Proactiveness: take initiative to tackle challenges without waiting to be asked Willingness: voluntarily offer to assist in additional projects or tasks when needed Adaptability: work efficiently under pressure or in changing environments

Requirements

Registered Nurse with a minimum of 5 years Clinical Experience
Excellent written, telephone, and computer skills
Positive, proactive, team-oriented approach/attitude
Time management and organizational skills, flexible, with the ability to work independently.
Active, unrestricted multi-state license
Recent clinical experience

Nice To Haves

Credentials such as CCM/CRRN, OCN or other pertinent certifications

Responsibilities

Provide appropriate, comprehensive, and proactive onsite and telephonic case management services.
Promote the provision of the highest quality, most appropriate, cost-effective healthcare to plan participants with chronic or catastrophic illnesses or injuries.
Perform all phases of the case management process, including defining role and scope of activities to the patient, gathering consent, determining individual needs through assessment, and considering medical and psychosocial issues.
Identify issues that might interfere with the provision of high-quality, appropriate, and cost-effective care.
Create and implement individualized plans of action based on assessment, facilitating coordination of appropriate and necessary treatment and services.
Provide patients with information to make informed decisions, empowering them through inclusion in the planning process.
Develop contingency plans and facilitate communication of patient wishes to the healthcare team.
Discuss advanced directives with patient/family when appropriate.
Obtain acceptance from all parties (patient, family, payer, providers) before instituting the plan.
Refer to providers who are familiar or have been researched to ensure high quality.
Evaluate the plan regularly to determine effectiveness, patient satisfaction, provider comfort, payer satisfaction, cost-effectiveness, patient compliance, and impact on quality of life.
Determine if revisions are required due to changes in medical condition, family status, insurance coverage, etc.
Maintain well-organized, objective, factual, clear, and concise documentation adhering to policies regarding timeliness.
Act as a patient advocate in an ethical manner, incorporating case management concepts and following industry standards and guidelines.
Become involved in the case management process as early as possible following onset or diagnosis and maintain involvement throughout the course of the illness or injury.