Lead Nurse Case Manager

Jobtailor; Kentucky; On-site; USD 65,000 - 90,000; Full time

Job summary

Jobtailor seeks a Telephonic Nurse Case Manager Lead to oversee care management for members with complex and chronic needs. You will conduct assessments, develop and implement individualized care plans, and coordinate authorizations and referrals across internal and external resources.

The role involves monitoring plan effectiveness and collaborating with Medical Directors and Physician Advisors to optimize outcomes.

Qualifications

• BA/BS in a health-related field with 5 years of clinical experience or equivalent background.
• Current, unrestricted RN license in applicable state(s).
• Case manager certification within 3 years of starting in this role.
• Managed care experience is required.
• Case management experience is a plus.

Responsibilities

• Telephonic Nurse Case Manager Lead responsible for care management within licensure.
• Conducts assessments to identify needs and creates a care management plan.
• Implements care plan by facilitating authorizations/referrals.
• Coordinates internal and external resources to meet needs.
• Monitors and evaluates effectiveness of the care plan and updates as needed.
• Interfaces with Medical Directors and Physician Advisors.
• Assists in problem solving with providers, claims or service issues.
• Participates in audit activities and assists supervisor with day-to-day management.

Education

BA/BS in health-related field

RN license

Case manager certification

Job description

Responsibilities

• Telephonic Nurse Case Manager Lead responsible for care management within the scope of licensure for members with complex and chronic care needs.
• Conducts assessments to identify individual needs and a specific care management plan to address objectives and goals.
• Implements care plan by facilitating authorizations/referrals.
• Coordinates internal and external resources to meet identified needs.
• Monitors and evaluates effectiveness of the care management plan and modifies as necessary.
• Interfaces with Medical Directors and Physician Advisors.
• Assists in problem solving with providers, claims or service issues.
• Participates in audit activities and assists supervisor with management of day-to-day activities.

Requirements

• Requires a BA/BS in a health related field and 5 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.
• Current, unrestricted RN license in applicable state(s) required.
• Case manager certification required within 3 years of starting in this role.
• Certification as a Case Manager is preferred.
• BS in a health or human services related field preferred.
• Managed care experience necessary.
• Case management experience a plus.