RN Nurse Case Management Lead Analyst - Accredo - Work from Home , Anywhere, USA

* Job Description Summary

Provides advanced professional input to complex Nurse Case Management assignments/projects.

Plans, implements, and evaluation of 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 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 effectiveness is maintained.

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, medical restrictions and limitations and expected duration.

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 directions to more junior professionals.

Works autonomously, only requiring "expert" level technical support from others.

Exercises judgment in the 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.

RN and current unrestricted nursing license required.

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POSITION SUMMARY

Provides case management support and education to patients on assigned caseload through remote contact with patients.

This includes relationship building, assisting with navigating insurance and pharmacy protocols to obtain medication, referral source, and customized product and disease state training.


* Adheres to principles as stipulated by program specific contractual agreements and company practices which may include:


* Interact and build relationships with assigned patients throughout the duration of the program.


* Provide patient centric education regarding treatment and disease states for assigned products.


* Manage caseload including schedule maintenance and adherence, scheduled calls/interactions, updating program database per company protocols.


* Coordinate meetings between patients and clinical partners.


* Deliver customized interactions based on patient's needs.


* Participates in program specific customer meetings and training sessions.


* Participates in program specific orientation meetings and demonstrates clinical and systems competency on tests.


* Performs special projects and performs other duties as it pertains to specific contract performance

QUALIFICATIONS


* Associate's degree and professional nursing license (current and valid) in state of practice


* 2-5 years relevant experi...