Lead Medical Management Nurse

$88,032 - $138,336/Yr

Elevance Health - Colorado, TX

Full-time - Mid Level

Colorado, TX

Insurance Carriers and Related Activities

About the position

The Lead Medical Management Nurse role is responsible for serving as the team lead, coach, and technical resource for a team of either Medical Management Nurses or Medical Management Clinicians. Contributes on hiring, promotion, and other job-progression decisions for the nurses on their team. Works on special projects and helps to craft, implement, and improve organizational policies. Serves as the subject matter expert and department liaison to other areas of the business unit or as the representative on enterprise initiatives.

Responsibilities

• Identifies the need for, and driving the execution of, process or policy improvements.
• Coordinates team members to ensure appropriate coverage.
• Provides valuable recommendations in hiring decisions, as well as promotions.
• Serves as a resource to lower-level nurses and clinicians.
• Provides training for staff.
• Improves materials used in orientation and training efforts.
• Completes quality audits and helps to develop and implement associated corrective action plans.
• Leads or participates on cross-functional teams, special projects, initiatives, and process improvement activities.
• Assists team members, as appropriate, with review of the most challenging and complex cases, as well as overflow cases.
• Works with healthcare providers to promote quality member outcomes, to optimize member benefits and promote effective use of resources.
• Consults with team members and Medical Directors to ensure medically appropriate, high-quality, cost-effective services.

Requirements

• Requires a minimum of associate's degree in nursing.
• Requires a minimum of 6 years care management or case management experience.
• Requires a minimum of 2 years clinical, utilization review, or managed care experience.
• Current active, valid and unrestricted RN license and/or certification to practice as a health professional within the scope of licensure in the state of Colorado and Nevada.

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution
• Paid Time Off
• Medical, dental, vision benefits
• Short and long term disability benefits
• Life insurance
• Wellness programs
• Financial education resources