Nurse Care Manager Lead - Case Management (RN)
About the role
The Nurse Care Manager Lead is responsible for care management of patients with acute and chronic medical conditions for various clients, plus acts as a subject matter expert and mentor to employees on the team.
Responsibilities
- Perform assessment and evaluation of potential care management patients per client contractual obligations and/or state requirements.
- Collaborate with health care providers and ancillary service providers to validate the appropriate treatment plan and identify educational opportunities.
- Effectively guide members to appropriate member benefit information.
- Provide ongoing education.
- Communicate with all health care providers to ensure appropriateness of care.
- Recommend and make adjustments in care if needed.
- Evaluate treatment adherence and reevaluate the patient’s commitment to make the necessary changes.
- Be available for assistance to team members and manager.
- Absolutely as mentor to new employees and assists in orientation.
- May assist with audits or quality monitoring as well as coordinating workload distribution.
- Escalate issues through appropriate channels, following established hierarchical protocols between clinical and non-clinical staff members.
- Document per contractual requirements related to individual member status, medical necessity review, negotiation.
- Recommends changes in policy or procedures to ensure a competitive advantage.
- 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
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.
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Contact Information
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.