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Lead Nurse Case Manager
Elevance Health. Conduct assessments to identify individual needs and develop care management plans .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in care management, including developing and implementing care plans, coordinating resources, and conducting assessments. Holds a current RN license and case manager certification, with a strong background in managed care and clinical experience.
Highest-signal resume keywords
Care ManagementClinical ExperienceCase Manager CertificationManaged Care ExperienceRN License
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Care Plan DevelopmentAssessment ConductingUtilization ManagementQuality AuditsProcess EvaluationConflict ResolutionTraining Material DevelopmentTelephonic Care ManagementHospital Discharge PlanningReimbursement Negotiation
Soft Skills
CoachingFeedback DeliveryInterdepartmental CollaborationPresentation SkillsProblem Solving
Certifications & Qualifications
Case Manager CertificationRN License
Industry Keywords
Managed CareCare Management PoliciesDisease ProcessesTraumatic InjuriesGrand RoundsCare Conferences
About the role
Key responsibilities & impact- Conduct assessments to identify individual needs and develop care management plans
- Implement care plans by facilitating authorizations and referrals
- Coordinate internal and external resources
- Monitor and evaluate care plan effectiveness and modify plans as necessary
- Interface with Medical Directors and Physician Advisors on treatment plans
- Negotiate reimbursement rates as applicable
- Help resolve provider, claims, and service issues
- Develop utilization and care management policies and procedures
- Chair and schedule meetings and present cases at Grand Rounds/Care Conferences
- Participate in interdepartmental and cross-brand workgroups
- Develop focused expertise in disease processes or traumatic injuries
- Serve as preceptor for new care management staff
- Participate in audits and assist with day-to-day workflow management
- Deliver constructive coaching and feedback and develop corrective action plans as directed
- Serve as first-line contact for conflict resolution
- Develop training materials
- Complete quality audits and process evaluations
- Test and monitor systems and process enhancements
- Perform care management telephonically or on-site, including hospital discharge planning
Requirements
What you’ll need- BA/BS in a health-related field and 5 years of clinical experience, or equivalent combination of education and experience
- Current, unrestricted RN license in applicable state(s) required
- Case manager certification required within 3 years of starting in the role
- Managed care experience necessary
- Case management experience is a plus
- Certification as a Case Manager preferred
- BS in a health or human services-related field preferred
- Ability to work Monday–Friday, 11:30 a.m.–8 p.m. EST
- Candidates must reside within a reasonable commuting distance from a posting location unless an accommodation is granted
- Certain patient/member-facing roles require COVID-19 and influenza vaccination unless an acceptable explanation is provided
Benefits
Comp & perks- $3000 sign-on bonus
- Merit increases
- Paid holidays
- Paid Time Off
- Incentive bonus programs
- Medical benefits
- Dental benefits
- Vision benefits
- Short-term disability benefits
- Long-term disability benefits
- 401(k) with match
- Stock purchase plan
- Life insurance
- Wellness programs
- Financial education resources
- Virtual work flexibility