Lead Nurse Case Manager

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. #J-18808-Ljbffr Jobtailor