Nurse Care Manager Lead - Case Management (RN)

Job Description

Job Description

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.

Preferred Qualifications

• 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.

Who We Are:

 

Telligen is one of the most respected population health management organizations in the country. We offer clinical, analytical, and technical expertise to support local, Tribal, and national partners, state and federal government programs, and employers and health plans.

 

Over our 50-year history, health care has evolved - and so have we. What hasn't changed is our deep commitment to those we serve. Our success is built on our ability to adapt, respond to client needs and deliver innovative, mission-driven solutions.

 

Our business is our people and we’re seeking talented individuals who share our passion and are ready to take ownership, make an impact and help shape the future of health.

 

Are you Ready?

 

We’re on a mission to transform lives and economies by improving health.

 

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.

Thank you for your interest in Telligen!

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While we use artificial intelligence tools to enhance our initial screening process, all applications are thoroughly reviewed by our human recruitment team to ensure a fair and comprehensive evaluation of each candidate.

Telligen and our affiliates are Equal Opportunity Employers and E-Verify Participants.

Telligen will not provide sponsorship for this position. If you will require sponsorship for work authorization now or in the future, we cannot consider your application at this time. We will not accept 3rd party solicitations from outside staffing firms.

 

Telligen is an equal opportunity employer. Qualified applicants will be considered without regard to race, color, religion, creed, sex, sexual orientation, gender identity, marital status, national origin, age, protected veteran status, disability or any other protected class.

 

Telligen is committed to ensuring that our employment process is open to all individuals, and provides reasonable accommodations to individuals who need assistance during any part of the employment process due to a disability, medical condition, or physical or mental impairment. Reasonable accommodations are considered on a case-by-base basis.

 

If you need assistance to navigate Telligen’s careers website or to apply for a position, please send an email to  View email address on ziprecruiter.com

We may use artificial intelligence (AI) tools to support parts of the hiring process, such as reviewing applications, analyzing resumes, or assessing responses and identifying potential inconsistencies or verification signals in application materials based on available information. These tools assist our recruitment team but do not replace human judgment. Final hiring decisions are ultimately made by humans. If you would like more information about how your data is processed, please contact us.