Nurse Case Manager II - Ohio

Description

Job Title

Nurse Case Manager


Location

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

• 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

Skills

• 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

• 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 handwritten and computer-generated documents as well as a PC monitor

Education

• RN with current unrestricted state licensure for state of Ohio

• Case Management Certification CCM preferred

• Verifyable High School Diploma or GED Required