Nurse Case Manager

Title: Nurse Case Manager

Mandatory skills:

Case Management

clinical practice,

home health, ambulatory care,

healthcare, managed care,

RN, Registered Nurse,

PC, computer documents,

case resolution, quality management,

benefits, benefit plan, benefits administration,

clinical tools, information review, data review,

case management plans, case management policies, case management procedures,

regulatory standards, compliance, regulatory guidelines, accreditation guidelines,

multitask, communication, inspection, meeting, assessment, planning, facilitation,

Case Management Certification, RN license

Description:

The Case Manager utilizes a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individuals benefit plan and/or health needs through communication and available resources to promote optimal, cost-effective outcomes. Requires an RN with unrestricted active license

Through the use of clinical tools and information/data review, conducts comprehensive assessments of referred member's needs/eligibility and determines approach to case resolution and/or meeting needs by evaluating member's benefit plan and available internal and external programs/services Application and/or interpretation of applicable criteria and guidelines, standardized case management plans, policies, procedures, and regulatory standards while assessing benefits and/or members needs to ensure appropriate administration of benefits Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures

Duties

Through the use of clinical tools and information/data review, conducts comprehensive assessments of referred member's needs/eligibility and determines approach to case resolution and/or meeting needs by evaluating member's benefit plan and available internal and external programs/services

Application and/or interpretation of applicable criteria and guidelines, standardized case management plans, policies, procedures, and regulatory standards while assessing benefits and/or member’s needs to ensure appropriate administration of benefits

Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures

Experience

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

Healthcare and/or managed care industry experience.

Case Management experience preferred-- Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding

Effective communication skills, both verbal and written.

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

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

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

Typical office working environment with productivity and quality expectations?

Requires an RN with unrestricted active license

Education

RN with current unrestricted state licensure.

Case Management Certification CCM preferred

Notes:

Mon-Fri 8-5

Onsite as needed

VIVA USA is an equal opportunity employer and is committed to maintaining a professional working environment that is free from discrimination and unlawful harassment. The Management, contractors, and staff of VIVA USA shall respect others without regard to race, sex, religion, age, color, creed, national or ethnic origin, physical, mental or sensory disability, marital status, sexual orientation, or status as a Vietnam-era, recently separated veteran, Active war time or campaign badge veteran, Armed forces service medal veteran, or disabled veteran. Please contact us at for any complaints, comments and suggestions.

Contact Details :

Account co-ordinator: Dinesh Kumar Udaya Kumar, Phone No: (847) 461-3640, Email: /

Account co-ordinator: Keerthana Bathrappan, Phone No: (847) 278-2460, Email:

VIVA USA INC.

3601 Algonquin Road, Suite 425

Rolling Meadows, IL 60008