Nurse Care Manager Lead - Case Management (RN)
About The Position
The Nurse Care Manager Lead is responsible for care management of patients with acute and chronic medical conditions for various clients, plus acts as subject matter expert and mentor to employees on the team. Essential Functions You will perform assessment and evaluation of potential care management patients per client contractual obligations and/or state requirements. You will collaborate with health care providers and ancillary service providers to validate the appropriate treatment plan and identify educational opportunities. You will effectively guides members to appropriate member benefit information. You will provide ongoing education. Communicates with all health care providers to ensure appropriateness of care. Recommends and makes adjustments in care if needed. Evaluates treatment adherence and reevaluates the patient’s commitment to make the necessary changes. You will be available for assistance to team members and manager. Acts as mentor to new employees and assists in orientation. May assist with audits or quality monitoring as well as coordinating workload distribution. Escalates issues through appropriate channels, following established hierarchical protocols between clinical and non-clinical staff members. You will document per contractual requirements related to individual member status, medical necessity review, negotiation. Recommends changes in policy or procedures to ensure a competitive advantage. You will stay abreast of health care trends and changes.
Requirements
- Four year degree in health care or related field and/or equivalent training and/or experience.
- Graduation from an accredited nursing school required.
- Current Registered Nurse (RN) license or licensure as a health care provider required.
- Minimum three (3) years of clinical practice experience.
- Demonstrated leadership capabilities.
- Ability to obtain required license(s) in state(s) by timeframe set by business not to exceed 6 months.
- This position may require advanced certifications or the ability to obtain certifications within designated timeline.
Nice To Haves
- Bachelor of Science in Nursing (BSN).
- Oncology (Onc) experience.
- Experience supporting members with acute and chronic medical conditions.
- Experience with care management and interdisciplinary care coordination.
Responsibilities
- Perform assessment and evaluation of potential care management patients per client contractual obligations and/or state requirements.
- Collaborate with health care providers and ancillary service providers to validate the appropriate treatment plan and identify educational opportunities.
- Effectively guide members to appropriate member benefit information.
- Provide ongoing education.
- Communicate with all health care providers to ensure appropriateness of care.
- Recommend and make adjustments in care if needed.
- Evaluate treatment adherence and reevaluate the patient’s commitment to make the necessary changes.
- Be available for assistance to team members and manager.
- Act as mentor to new employees and assist in orientation.
- Assist with audits or quality monitoring as well as coordinating workload distribution.
- Escalate issues through appropriate channels, following established hierarchical protocols between clinical and non-clinical staff members.
- Document per contractual requirements related to individual member status, medical necessity review, negotiation.
- Recommend changes in policy or procedures to ensure a competitive advantage.
- Stay abreast of health care trends and changes.
Benefits
- 100% employee-owned company
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
