Nurse Case Manager II - Central OH

Job Title:

Nurse Case Manager II - Central OH

Address:

Field-Ohio (Field) (OH001F)

Job Description:

Conduct comprehensive assessments of referred member's needs/eligibility and determine 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 memberâ s needs to ensure appropriate administration of benefits.

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

Use clinical tools and information/data review to assess member's benefit plan and available internal and external programs/services.

Facilitate and advocate for options and services to meet an individualâ s benefit plan and/or health needs through communication and available resources.

Work with members to promote optimal, cost-effective outcomes.

Collaborate with various stakeholders to ensure effective case management and quality care. Critical Information:

Shift/Hours: 8am-5pm, Monday-Friday

Job Duration: 13.0 months

Remote: NO

Onsite Requirements: Onsite as needed Education/Licenses Needed:

RN with current unrestricted state licensure

Case Management Certification (CCM) preferred

High School Diploma or GED Required: Yes Benefits:

Benefits are available to full-time employees after 90 days of employment.

A 401(k) with company match is available after 1 year of service.

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