Nurse Case Mgr Lead 40413 - (US-CA-Camarillo - 93012)

Minimum Education: Tech School
Job Type: Full Time
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WellPoint
is the nation's leading health benefits insurer and a Fortune Top 50 company. At WellPoint, we are dedicated to improving the lives of the people we serve and the health of our communities. WellPoint strives to provide the best health care value for our customers.
Bring your expertise to our innovative, achievement-driven culture, and you will discover lasting rewards and the opportunity to take your career further than you can imagine.
Nurse Case Manager Lead, duties include managing multiple projects simultaneously. Two or more years of demonstrated experience leading team of Case Managers in managed health care organization. Leading team and performing 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. 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 cares for discussion at Grand Rounds/Care Conferences and participates in interdepartmental and/or cross brand workgroups. This position may require the development of a focused skill set including comprehensive knowledge of specific disease process or traumatic injury and will function as preceptor for new care management staff.

Skills:
Requires BA/BS or higher in a health related field and licensure as a health professional, or certification as a care manager, or current unrestricted RN license in applicable state(s) and 5 years clinical experience or any combination of education and experience, which would provide an equivalent background. BA/BS in nursing, certification in appropriate product/service, clinical or care management experience appropriate to demands preferred. Requires knowledge of health insurance/benefits. Requires knowledge of care management assessment technique, provider community, and community resources. 3 years experience in home health/discharge planning preferred. Must have strong oral, written and interpersonal communication skills, PC skills to include word processing, spreadsheet, and database applications, organizational and problem-solving skills, decision-making skills, and evidence of leadership skills. Experience in Qualtiy writing studies a plus. Position may exist in several locations with possobility of work from home after designated training time. Travel 25% of time. WellPoint is ranked as one of America's Most Admired Companies among health insurers by Fortune magazine and is a 2009 DiversityInc magazine Top 50 Company for Diversity.

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