Job title: RN Nurse Case Management Lead Analyst- SCO (Pathwell) - Work from Home, Anywhere Company: reputed company Job description: • Provides advanced professional input to complex Nurse Case Management assignments/projects. Plans, implements, and evaluates appropriate reputed company services in conjunction with the physician treatment plan. Handles more complex, high reputed company reputed company, and/or account sensitive reputed company 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 reputed company objectives are met by evaluating the effectiveness of alternative care services and that cost effective, quality care is maintained. Performs prospective, concurrent, and retrospective reviews for inpatient acute care, rehabilitation, referrals, and select outpatient services. May review reputed company 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 reputed company. Supports and provides direction 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 reputed company to develop models and procedures, and monitor trends, within Nurse Case Management. RN and current unrestricted nursing license required. Summary Description of Position Manages a caseload of customers that require specialty drugs, evaluating the need for alternative services and as appropriate; assesses, plans, implements, coordinates, monitors, and evaluates options and services to meet an individual's healthcare needs. Through communication and available resources, the Case Manager promotes care coordination, provider collaboration, quality case outcomes, and provides quality, cost effective alternatives to care as appropriate. As an owner of reputed company, the Case Manager performs clinical review of medical specialty pharmacy services, coordinates transition of care, product rate negotiations, and accurately calculates medical cost savings. Case Managers performs case management evaluation to identify any clinical needs, social determinants of health needs, discuss programs and services available with referrals as appropriate, and coordinates care and closes gaps through collaboration with customers, treating physicians, and servicing providers. Major Job Responsibilities and Required Results • Obtains informed verbal consent from customers for case management services • Establishes a collaborative relationship with reputed company (plan participant), family, physician(s), facilities, specialty pharmacies, and other providers to determine medical history and current status to assess the appropriate level of care and options for alternative care. • Assistance in the identification of member health education needs through health assessment activities • Utilization of health prevention guidelines and general health and wellness strategies to achieve goals in the overall health of members. • Perform research on relevant topics in health promotion and disease prevention, as required for specific members • Consult with and assist team members in reputed company where a member's reputed company or emotional issues are impacting their ability to set and/or achieve goals • . • Educate and refer members on available internal and external health resources • Provides 1:1 telephonic coaching to members around their behavior reputed company to improve health status, reduce health risks and improve quality of life. • Assesses readiness to reputed company and implements actions to assist members in moving through stages of reputed company to reach their goals • Work with members to identify and set personalized health improvement plans and goals and support members in achieving those goals. • 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 reputed company, 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