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
Recommended Jobs
Machinist 24-27/hr Depending On Experience
***CNC Machinist $24-27/hr!*** All Shifts Available If interested, please apply then text Madelyn to hear details about it: 513-229-2034** Job Description: The machinist role involves operat…
Get paid for taking free surveys with Unlock Surveys
Engage in surveys and discussions to earn rewards! Join Unlock's dynamic community of survey panellists today and begin earning rewards for sharing your valuable opinions. Formerly known as Springbo…
Foundry Laborer
Job Description Job Description Are you looking for a long-term job with a great company? Barberton Mancan is looking for Foundry Workers for a company in Uniontown. Foundry Assistant 3rd Mond…
Construction Laborer
Job Description Job Description Reports To: Mitigation Manager What does a Construction Laborer with Paul Davis do? Serve others within your community in their time of need Make a differe…
Sr. Account Management Representative
Job Description Job Description At Vector Security We Think Big, Do the Right Thing, and Make a Difference Every Day! If this is how you like to work, we’d like to invite you to join our team a…
Dietary Aide Casual
Job Description Job Description NEW WAGE: $14.41 Copeland Oaks, a non for-profit Continuing Care Retirement Community has openings for casual and part time Diet Aides . Copeland Oaks is locat…
Oracle Senior Business Systems Analyst (Oracle EBS, Order to Cash, Oracle OSB, SQL, PL-SQL) in Cleveland, OH
Oracle Senior Business Systems Analyst (Oracle EBS, Order to Cash, Oracle OSB, SQL, PL-SQL) in Cleveland, OH Clear Orbit, Manufacturing Industry, Oracle Business Systems Analyst, Oracle EBS, Oracle O…
IT Technician (Onsite)
Job Description Job Description Description: About the Company United Rolls Inc. is the global leader in the design and manufacture of iron and high alloy rolls for the metal processing indus…
Mailroom Clerk
Job Responsibilities: Receive, sort, and distribute incoming mail and packages to appropriate departments or personnel. Prepare outgoing mail, including packaging, labeling, and arranging for p…
Material Handler - 3rd Shift
Job Description Job Description Location: Jackson Center, Ohio Employment Type: 3rd Shift, Full-time, temp-to-hire Job Brief Kable Workforce Solutions is hiring a Material Handler for …