RN- Financial Nurse Case Manager- PACE Team- Accredo- Remote
About the position
The Financial RN Case Management Lead Analyst role is a key position within the PACE (Precision, Care, Agility and Engagement) program, focusing on providing proactive prior authorization requests for specialized therapies. This role involves managing complex cases, ensuring effective healthcare outcomes, and supporting junior professionals in their case management duties.
Responsibilities
Provides advanced professional input to complex Nurse Case Management assignments/projects.
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Plans, implements, and evaluates appropriate health care services in conjunction with the physician treatment plan.
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Handles more complex, high acuity cases, and/or account sensitive cases involving largest reserves.
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Utilizes clinical skills to assess, plan, implement, coordinate, monitor and evaluate options and services to facilitate appropriate healthcare outcomes for members.
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Ensures that case management program objectives are met by evaluating the effectiveness of alternative care services and maintaining cost-effective, quality care.
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Performs prospective, concurrent, and retrospective reviews for inpatient acute care, rehabilitation, referrals, and select outpatient services.
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May review initial liability disability claims to determine extent and impact of insured's medical condition, medical restrictions and limitations and expected duration.
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Performs leadership role on team when implementing new tools or case management programs/initiatives.
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Manages own caseload and coordinates all assigned cases.
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Supports and provides direction to more junior professionals.
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Works autonomously, only requiring "expert" level technical support from others.
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Exercises judgment in the evaluation, selection, and adaptation of both standard and complex techniques and procedures.
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Utilizes in-depth professional knowledge and acumen to develop models and procedures, and monitor trends, within Nurse Case Management.
Requirements
RN and current unrestricted nursing license required.
Nice-to-haves
Benefits
Comprehensive health-related benefits including medical, vision, and dental coverage.
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Well-being and behavioral health programs.
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401(k) with company match.
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Company paid life insurance.
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Tuition reimbursement.
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Minimum of 18 days of paid time off per year.
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Paid holidays.
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