Nurse Case Manager Senior Analyst

Job Description:

Responsibilities

• Uses clinical knowledge to assess the treatment plan and goals and identifies gaps in care or risks for readmission or complications.
• Assesses member’s health status and treatment plan and identifies any gaps or barriers to healthcare.
• Establishes a documented patient centric case management plan involving all appropriate parties (client, physician, providers, employers, etc.)
• Interfaces with the member, family members/caregivers, and the healthcare team/provider, as well as internal matrix partners.
• Identifies anticipated case results/outcomes, criteria for case closure, and promotes communication within all parties involved.
• Maintains accurate record (system) of case management interventions including cost/benefit analysis, savings, and data collection.
• Evaluates medical information against criteria, benefit plan, coverage policies and determines medical necessity.
• Build solid working relationships with internal staff, matrix partners, key functional areas, customers, and providers
• Based on experience, may provide leadership, preceptor/mentorship, support and coverage to other case management staff and assist case managers in achieving positive outcomes and savings.
• Assists Utilization Review as needed/requested.
• Participates in unit and corporate training initiatives and demonstrates evidence of continuing education to maintain clinical expertise and certification as appropriate.
• Adheres to professional practice within scope of licensure and certification quality assurance standards and all case management policy and procedures

Qualification & Experience

• Nurse Licensure. MSc Nursing
• Language skills: Fluent reading, writing and speaking English; any additional language is a plus.
• Demonstrated strong organizational and leadership skills.
• Strong interpersonal and communication skills.
• Demonstrates problem-solving and analytical skills.
• Knowledge of utilization or case management, cost containment services, managed care, insurance coverage, and financial management preferred.