Nurse Case Manager Senior responsible for assessing, developing, and coordinating member care plans. Working in the Albany, GA area to support members with complex and chronic care needs.
Responsibilities
Ensures member access to services appropriate to their health needs
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
Assists in problem solving with providers, claims or service issues
Coordinate referrals to local and statewide resources including behavioral health, housing, transportation, and food assistance
Partner with community health organizations, advocacy groups, and outreach teams to strengthen member connections
Plan, coordinate, and deliver educational events in collaboration with community partners, employers, or local health organizations
Provide group-based and one-on-one education on chronic conditions, medication adherence, preventive screenings, nutrition, and self-care
Support initiatives that address health equity and promote culturally responsive care
Assists with development of utilization/care management policies and procedures, chairs and schedules meetings, 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 department audit activities
Requirements
Requires BA/BS in a health-related field and minimum of 5 years of clinical experience
Current, unrestricted RN license in applicable state(s) required
Nursing experience in Home Health, Managed Care, Case Management, or Care Coordination preferred
Manage the Semi Test Demand Management team in the supply chain at Teradyne. Lead a high - performing team and drive strategic demand planning processes to optimize operations.
Medical Review Manager focused on compliance and strategic opportunities in promotional materials for Pfizer. Collaborating across teams to ensure high compliance standards in Denmark and Norway.
Praxismanager overseeing operations in an oncology practice in Rheinbach. Leading a team and ensuring quality patient care during oncological therapy with structured onboarding and training.
Project Manager for construction projects in healthcare facilities at Johanniter GmbH. Leading project initiatives and ensuring compliance with regulations in a flexible work environment.
Safety Manager overseeing safety programs and compliance, conducting inspections and investigations, and providing training. Role involves collaboration with management to uphold safety standards across operations.
Research Manager leading interdisciplinary healthcare research strategies for Women's Health Ultrasound at GE HealthCare. Collaborating with academic and clinical partners to drive impactful research outcomes.
Senior Manager leading a team of Program Managers for Medication Management Solutions deployment. Ensuring customer satisfaction through efficient implementations and cross - functional collaboration.
Senior Sales Lead at Wavestone, driving business growth and client relationships in the insurance sector. Focused on strategic planning and mentoring junior team members while ensuring high - quality service delivery.
HSE Manager at Hitachi Energy developing and maintaining HSE management systems. Ensuring compliance with regulations and leading training programs for employees.