Nurse Case Manager II

Nurse Case Manager IIThe 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.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/servicesApplication 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 benefitsUtilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and proceduresExperience: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 keyboardingEducation:RN with current unrestricted state licensure in state of PA or a compact licenseAssociate's of Science in Nursing (ASN) degree and relevant experience in a health care-related field (REQUIRED)Bachelor's of Science in Nursing (BSN) (PREFERRED)Case Management Certification CCM preferred