Job Title: Case Manager
Location: Nashville, TN
Job Type: Contract
Expected hours per week (must include “per week”):
40 hours per week
Schedule (include days, hours, onsite/hybrid or remote):
Monday – Friday, 9-5, Remote.
Pay Range (must include “per hour”):
$45.50 per hour
Job Description:
About the Role
Position Summary
The Nurse Case Management Senior Analyst delivers delegated clinical and administrative tasks within the Nurse Case Management job family. In this role, you will apply your clinical expertise to assess, plan, coordinate, and evaluate healthcare services that support positive member outcomes while ensuring cost?effective, high?quality care.
This position manages a personal caseload, supports utilization management activities, and performs case management reviews across multiple settings. While work is performed independently, guidance and support from senior clinical team members is always available.
Key Responsibilities
- Conduct comprehensive clinical assessments and develop individualized care plans aligned with physician treatment plans.
- Coordinate, monitor, and evaluate services and resources to optimize member outcomes.
- Perform prospective, concurrent, and retrospective reviews for:
- Inpatient acute care
- Rehabilitation services
- Referrals
- Select outpatient services
- Provide health education and support to members to promote engagement and adherence.
- Evaluate effectiveness of alternative care services to maintain quality and cost?efficiency.
- Manage and prioritize assigned caseload in compliance with program standards.
- Resolve non?routine issues escalated by junior team members.
- Complete day?to?day case management activities with minimal supervision.
Required Qualifications
- Active, unrestricted Registered Nurse (RN) license
- Strong clinical assessment, critical thinking, and care coordination skills
- Ability to work independently while collaborating effectively with cross?functional teams
- Experience with utilization management or case management preferred
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