Previous Job
Nurse Case Management Senior Analyst (AL)
Ref No.: 20-03061
Location: Birmingham, Alabama

Title: Nurse Case Management Senior Analyst
Location: Birmingham, AL | Nashville, TN
Start Date: ASAP
Hours: Mon - Fri, 8am - 5pm

*This position with start remote but will eventually move onsite. Must be local to Birmingham or Nashville areas*

Role Summary:

This Nurse Case Manager Senior Analyst will promote the improvement of health outcomes to members and assist those members experiencing the burdens of illness and injury. The Case Manager will assess, plan, implement, coordinate, monitor and evaluate options and services to meet an individual's health needs within case load assignments of a defined population based on business perspectives.

Position Scope:

  • Manages/coordinates an active caseload of case management cases for Medicare.
  • Uses clinical knowledge to assess the treatment plan and goals, and identifies gaps in care or risks for readmission or complications.
  • Establishes patient centric goals and interventions to meet the member's needs
  • Interfaces with the member, family members/caregivers, and the healthcare team, and embedded care coordinator as well as internal matrix partners.
  • Build solid working relationships with internal staff, matrix partners, key functional areas, customers, and providers

Major Responsibilities:

  • Obtains informed verbal consent and takes all steps to obtain written consent as appropriate.
  • Establishes a collaborative relationship with client (plan participant/member), family, physician(s), and other providers to determine medical history and current status and to assess the options for optimal outcomes.
  • Promote consumerism through education and health advocacy.
  • 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), identifies anticipated case results/outcomes, criteria for case closure, and promotes communication within all parties involved.
  • Implements, coordinates, monitor and evaluate the case management plan on an ongoing, appropriate basis.
  • Adheres to professional practice within scope of licensure and certification quality assurance standards and all case management policy and procedures
  • Participates in unit and corporate training initiatives and demonstrates evidence of continuing education to maintain clinical expertise and certification as appropriate.
  • Demonstrates sensitivity to culturally diverse situations, clients and customers

Competencies Preferred:

  • Excellent time management, organizational, research, analytical, negotiation, communication (oral and written) and interpersonal skills
  • Strong personal computer skills, MS word, Excel, Outlook experience, and Internet research desired
  • Strong skills in the following areas: teamwork, conflict management, assessment complex issues, ability to recommend changes and resolve problems through effective decision making
  • Experience in medical management and case management in a managed care setting is highly desirable
  • Knowledge of managed care products and strategies
  • Demonstrated sensitivity to culturally diverse situations, participants and customers

Minimum Requirements:

  • Active unrestricted Registered Nurse (RN) license in state or territory of the United States
  • Two years full-time equivalent of direct clinical care to the consumer
  • CCM Certification preferred
  • Open to any candidate in a compact state, prefer AL or near Nashville.

Preferred Requirements:

  • Within three (3) years of hire as a case manager, the case manager will become CCM certified