Nurse Case Manager II

Job 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:

• Minimum 3 years of experience.
• Must be flexible and adaptable.
• Strong basic computer skills required (Excel filtering, Outlook, email).
• Must be comfortable with home visits, nursing facilities, and hospitals.

Education/Experience:

• RN with current unrestricted state licensure and Case Management Certification/ CCM – preferred