Nurse Case Manager II

Job Description

Description:

Return Hires:

Rebecca Kearney

Franklin, Union, Deleware, Pickaway, and MadisonCounties.

The Case Manager utilizes a collaborative process ofassessment, planning, facilitation and advocacy for options and services tomeet an individuals benefit plan and/or health needs through communication andavailable resources to promote optimal, cost-effective outcomes. Requires an RNwith unrestricted active license

Through the use of clinical tools and information/datareview, conducts comprehensive assessments of referred member\'sneeds/eligibility and determines approach to case resolution and/or meetingneeds by evaluating member\'s benefit plan and available internal and externalprograms/services Application and/or interpretation of applicable criteriaand guidelines, standardized case management plans, policies, procedures, andregulatory standards while assessing benefits and/or members needs to ensureappropriate administration of benefits Utilizes case management and qualitymanagement processes in compliance with regulatory and accreditation guidelinesand company policies and procedures

Duties:

Through the use of clinical tools and information/datareview, conducts comprehensive assessments of referred member\'sneeds/eligibility and determines approach to case resolution and/or meetingneeds by evaluating member\'s benefit plan and available internal and externalprograms/services

Application and/or interpretation of applicablecriteria and guidelines, standardized case management plans, policies,procedures, and regulatory standards while assessing benefits and/or membersneeds to ensure appropriate

administration of benefits

Utilizes case management and quality management processesin compliance with regulatory and accreditation guidelines and company policiesand procedures

Experience:

3 years Clinical practice experience, e.g., hospitalsetting, alternative care setting such as home health or ambulatory carerequired.

Healthcare and/or managed care industry experience.

Case Management experience preferred-- Position requiresproficiency with computer skills which includes navigating multiple systems andkeyboarding

Effective communication skills, both verbal and written.

Ability to multitask, prioritize and effectively adapt toa fast paced changing environment

Sedentary work involving periods of sitting, talking,listening. Work requires sitting for extended periods, talking on the telephoneand typing on the computer.

Work requires the ability to perform close inspection ofhand written and computer generated documents as well as a PC monitor.

See members in their home and documentation from homeoffice.

Position Summary:

The Case Manager utilizes a collaborative process ofassessment, planning, facilitation and advocacy for options and services tomeet an individuals benefit plan and/or health needs through communication andavailable resources to promote optimal, cost-effective outcomes.

Requires an RN with unrestricted active license

Education:

RN with current unrestricted state licensure.

Preferred case management experience

What days & hours will the person work in thisposition List training hours, if different.

M-F 8-5

Full-time

Fully remote