Nurse Case Manager II - Ohio

The team will be doing TEAMS interviews for this job posting

Candidate DOES NOT need to live in Ohio if they have a compact license. If they live in OH they need to have an active unrestricted OH license or compact license. Screenshot of license needed at top of resume.

This role is a WFH telephonic position. No travel will be required. Candidates must have a quite place to work with no distractions due to HIPPAA Compliance. Candidates must work EST hours. 8am-5pm EST.

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. Requires an RN with unrestricted active license.[br style=\'box-sizing: inherit; margin: 0px; padding: 0px;\'][br style=\'box-sizing: inherit; margin: 0px; padding: 0px;\']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

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/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

Experience
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
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 hand written and computer generated documents as well as a PC monitor.
Typical office working environment with productivity and quality expectations

Position Summary
The Case Manager utilizes a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individuals benefit plan and/or health needs through communication and available resources to promote optimal, cost-effective outcomes.
Requires an RN with unrestricted active license in the state of OH or compact license.

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

What days & hours will the person work in this position List training hours, if different.
M-F 8AM-5PM EST