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 members 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
• Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding

Education/Experience:

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