Nurse Case Management Lead Analyst

Job Description: • Provides advanced professional input to complex Nurse Case Management assignments/projects • Plans, implements, and evaluates appropriate health care services in conjunction with the physician treatment plan • Handles more complex, high acuity cases, and/or account sensitive cases involving largest reserves • Utilizes clinical skills to assess, plan, implement, coordinate, monitor and evaluate options and services to facilitate appropriate healthcare outcomes for members • Ensures that case management program objectives are met by evaluating the effectiveness of alternative care services • Performs prospective, concurrent, and retrospective reviews for inpatient acute care, rehabilitation, referrals, and select outpatient services • May review initial liability disability claims to determine extent and impact of insured's medical condition • Performs leadership role on team when implementing new tools or case management programs/initiatives • Manages own caseload and coordinates all assigned cases • Supports and provides direction to more junior professionals • Works autonomously, only requiring “expert” level technical support from others • Exercises judgment in evaluation, selection, and adaptation of both standard and complex techniques and procedures • Utilizes in-depth professional knowledge and acumen to develop models and procedures, and monitor trends, within Nurse Case Management Requirements: • Registered Nurse (RN) license in state of primary residence • BSN preferred • Compact nursing license preferred • Minimum 2 years of nursing experience in prior authorizations or case management • Proficiency with Microsoft Office; basic database navigation • Knowledge of pharmacy, pharmaceuticals, life sciences, or healthcare business required • Ability to multitask in PC/Phone tasks Benefits: • Medical, vision, and dental benefits • Well-being and behavioral health programs • 401(k) • Company paid life insurance • Tuition reimbursement • Minimum of 18 days of paid time off per year • Paid holidays Apply tot his job