Job Description
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Role Description
- The Nurse Case Management Lead Analyst will:
- Provides advanced professional input to complex Nurse Case Management assignments/projects.
- Plans, implements, and evaluates appropriate health care services in conjunction with the physician treatment plan.
- Handles more complex, high acuity cases, and/or account sensitive cases involving largest reserves.
- Utilizes clinical skills to assess, plan, implement, coordinate, monitor and evaluate options and services in order to facilitate appropriate healthcare outcomes for members.
- Ensures that case management program objectives are met by evaluating the effectiveness of alternative care services and that cost effective, quality care is maintained.
- Performs prospective, concurrent, and retrospective reviews for inpatient acute care, rehabilitation, referrals, and select outpatient services.
- May review initial liability disability claims to determine extent and impact of insured's medical condition, medical restrictions and limitations and expected duration.
- Performs leadership role on team when implementing new tools or case management programs/initiatives.
- Manages own caseload and coordinates all assigned cases. Supports and provides direction to more junior professionals.
- Works autonomously, only requiring “expert” level technical support from others.
- Exercises judgment in the evaluation, selection, and adaptation of both standard and complex techniques and procedures.
- Utilizes in-depth professional knowledge and acumen to develop models and procedures, and monitor trends, within Nurse Case Management.
- Qualifications
- Registered Nurse (RN) license in state of primary residence.
- BSN preferred.
- Compact nursing license preferred.
- Minimum 2 years of nursing experience in prior authorizations or case management.
- Proficiency with Microsoft Office; basic database navigation.
- Knowledge of pharmacy, pharmaceuticals, life sciences, or healthcare business required.
- Ability to multitask in PC/Phone tasks.
- Teamwork and communication skills required.
- Requirements
- If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.
- Benefits
- Comprehensive health-related benefits including medical, vision, dental, and well-being and behavioral health programs.
- 401(k) with company match.
- Company paid life insurance.
- Tuition reimbursement.
- A minimum of 18 days of paid time off per year and paid holidays.
- Eligible to participate in an annual bonus plan.
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