Nurse Case Manager II

Description

Job Title

Nurse Case Manager

Location

Richmond, VA

Position Description

The Case Manager utilizes a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individual's benefit plan and/or health needs through communication and available resources to promote optimal, cost-effective outcomes.

Roles Responsibilities

• Conducts comprehensive assessments of referred member's needs/eligibility and determines approach to case resolution by evaluating member's benefit plan and available 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.

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

• Expected to travel to various hospital facilities to meet with members and hospital staff.

• Collaborate with the assigned case manager to report visit findings.

Skills

• Prior clinical practice experience in hospital setting, alternative care setting such as home health or ambulatory care required.

• Healthcare and/or managed care industry experience.

• Case Management experience preferred.

• Proficiency with computer skills including 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.

• Must have reliable transportation.

Education

• RN with current unrestricted state licensure.

• Case Management Certification CCM preferred.

• Verifyable High School Diploma or GED Required.