Nurse Case Management Senior Analyst

• This role requires either Saturday or Sunday as part of their regular scheduled shift.
• This is a remote position, but candidates must reside in either TX, IL, NM, OK, MT, or TN.

Job Summary:

• Delivers specific delegated tasks assigned by a supervisor in the Nurse Case Management job family.
• Plans, implements, and evaluates appropriate health care services in conjunction with the physician treatment plan.

Responsibilities:

• Utilizes clinical skills to assess, plan, implement, coordinate, monitor, and evaluate options and services in order to facilitate appropriate healthcare outcomes for members.
• Ensures that case management program objectives are met by evaluating the effectiveness of alternative care services and that cost-effective, quality care is maintained.
• Provides clinical assessments, health education, and utilization management to members.
• Performs prospective, concurrent, and retrospective reviews for inpatient acute care, rehabilitation, referrals, and select outpatient services.
• Manages own caseload and coordinates all assigned cases.
• Completes day-to-day Nurse Case Management tasks without immediate supervision, but has ready access to advice from more experienced team members.
• Tasks involve a degree of forward planning and anticipation of needs/issues.
• Resolves non-routine issues escalated from more junior team members.

Qualifications:

• RN and current unrestricted nursing license required.