Clinical Case Management Role Overview
Nurse Case Manager Analyst
This position focuses on enhancing clinical outcomes for members by providing support during illness and injury through the case management process.
The Clinical Case Manager assesses individual health needs, plans interventions, coordinates care, monitors progress, and evaluates outcomes within a defined population.
Key Responsibilities:
* Treatment Plan Development: Utilizes clinical knowledge to create customer-centric treatment plans, identifies care gaps, and mitigates risks for readmission or complications.
* Member Engagement: Engages with members, family members/caregivers, healthcare teams/providers, and internal partners to ensure effective communication and collaboration.
* Data Collection and Record Keeping: Maintains accurate records of case management interventions, including cost/benefit analysis, savings, and data collection.
* Clinical Decision Making: Evaluates medical information against criteria, benefit plans, coverage policies, and determines medical necessity.
Requirements:
* Nursing Licensure: Current nurse licensure is required for this role.
* Linguistic Proficiency: Fluent in reading, writing, and speaking English. Native Japanese speaker with fluency in Katakana, Kanji, and Hiragana; additional languages are an asset.
* Skillset: Strong organizational, leadership, interpersonal, and communication skills are essential. Problem-solving and analytical skills are also critical.
We prioritize promoting diversity, equity, and inclusion in our workplace culture.
About This Role: As a Clinical Case Manager Analyst, you will play a vital part in ensuring the best possible outcomes for our members. If you possess strong clinical knowledge, excellent communication skills, and a passion for patient-centered care, we encourage you to apply for this challenging and rewarding opportunity.