Nurse Case Manager Lead
Core
Lead a team of telephonic nurse case managers to assess, develop, and coordinate care plans for members with complex and chronic care needs, optimizing healthcare access and outcomes.
Role type
Senior IC Nurse Case Manager Lead (Team Lead)
Builds
Care management plans and utilization policies for health plan members
Domain
Health Insurance / Managed Care
Deliverable
client delivery
Required skills
RN licensure, care plan development, provider negotiation, care coordination, audit management, staff coaching, policy development
Preferred skills
Case manager certification, managed care experience, preceptor experience
Technologies
None stated
Responsibilities
Conduct assessments to identify individual needs and develop specific care management plans; Implement care plans by facilitating authorizations and referrals; Coordinate internal and external resources to meet identified needs; Monitor and evaluate effectiveness of care management plans; Interface with Medical Directors and Physician Advisors on treatment plans; Negotiate rates of reimbursement; Assist in problem solving with providers and claims issues; Assist with development of utilization/care management policies and procedures; Serve as first line contact for conflict resolution; Participate in audit activities and manage day-to-day team activities including workflow monitoring and coaching.
Seniority
Senior, hands-on IC with team leadership responsibilities