Search jobs > Topeka, KS > Lead case manager

Nurse Case Manager Lead - Kansas at Elevance Health

DirectEmployers
Topeka, KS, US
Full-time

The Nurse Case Manager Lead is responsible for care management within the scope of licensure for members with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum and ensuring member access to services appropriate to their health needs.

Performs duties telephonically or on-site such as at hospitals for discharge planning. Primary duties may include, but are not limited to :

Conducts assessments to identify individual needs and a specific care management plan to address objectives and goals as identified during assessment.

Implements care plan by facilitating authorizations / referrals as appropriate within benefits structure or through extra-contractual arrangements.

Coordinates internal and external resources to meet identified needs.

Monitors and evaluates effectiveness of the care management plan and modifies as necessary.

Interfaces with Medical Directors and Physician Advisors on the development of care management treatment plans.

Negotiates rates of reimbursement, as applicable.

Assists in problem solving with providers, claims or service issues.

Assists with development of utilization / care management policies and procedures, chairs and schedules meetings, as well as presents cases for discussion at Grand Rounds / Care Conferences and participates in interdepartmental and / or cross brand workgroups.

May require the development of a focused skill set including comprehensive knowledge of specific disease process or traumatic injury and functions as preceptor for new care management staff.

Participates in audit activities and assists supervisor with management of day-to-day activities, such as monitoring and prioritizing workflow, delivering constructive coaching and feedback, and developing associated corrective action plans at direction of the manager.

Serves as first line contact for conflict resolution.

Develops training materials, completes quality audits, performs process evaluations, and tests and monitors systems / process enhancements.

Requirements :

a BA / BS in a health related field and 5 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.

Current, unrestricted RN license in applicable state(s) required.

Certification as a Case Manager is preferred

Compensation Information :

$0.0 / - $0.0 /

Starting At : 0.0

Up To : 0.0

23 hours ago
Related jobs
Promoted
Midwest Health
Topeka, Kansas

Utilizing physicians' orders and professional skills, the RN Case Manager develops and implements a home health plan that meets each patient's specific needs and is in compliance with federal and state regulations, reimbursement guidelines, as well as Agency policies and procedures. Establishes pati...

Promoted
University of Kansas Health System St. Francis Campus
Topeka, Kansas

Then keep up to date with your job application process and conversations with our easy to use app. Ethos Medical Staffing is seeking a travel nurse RN Telemetry for a travel nursing job in Topeka, Kansas. United States, so you can compare Travel opportunities matching your desired criteria. Topeka, ...

DirectEmployers
Topeka, Kansas

Elara Caring provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to sex (including pregnancy, childbirth or related medical conditions), race, color, age (40 and older), national origin, religio...

Faith Home Health & Hospice
Topeka, Kansas

As a Registered Nurse (RN) for Faith, you will provide one-on-one skilled nursing care to patients using a comprehensive, patient-specific care plan set by the Director of Nursing which establishes goals based on nursing diagnosis and incorporates preventative and rehabilitative nursing actions. Are...

Elevance Health
Kansas

Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital s...

DirectEmployers
Topeka, Kansas

Elara Caring provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to sex (including pregnancy, childbirth or related medical conditions), race, color, age (40 and older), national origin, religio...

Ardent Health Services The University of Kansas Health System - Saint Francis Campus
Topeka, Kansas

Block Scheduling: Case by case. ...

DirectEmployers
Topeka, Kansas
Remote

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, age, religion, sex, national origin, sexual orientati...

Elevance Health
Topeka, Kansas

Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital s...

Elevance Health
Kansas

Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital s...