Nurse Care Manager Lead - Case Management (RN)

Telligen • Oklahoma City, OK

4d

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.

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 guides members to appropriate member benefit information.
• 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.
• 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.
• Document per contractual requirements related to individual member status, medical necessity review, negotiation. Recommends changes in policy or procedures to ensure a competitive advantage.
• Stay abreast of health care trends and changes.

Benefits

• Ownership: As a 100% employee-owned company, our employee-owners drive our business and share in our success.
• Community: We show up - for our clients, our communities and each other. Being a responsible corporate partner is part of who we are.
• Ingenuity: We value bold ideas and calculated risks. Innovation thrives when we challenge the status quo and listen to diverse perspectives.
• Integrity: We foster a respectful, inclusive, and collaborative environment built on trust and excellence.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level