Nurse Case Manager II
Job Responsibilities:
- Using 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 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:
- Case Management Certification CCM preferred and RN with current unrestricted state licensure.
Recommended Jobs
Home Improvement Project Estimator
Home Improvement Project Estimator Role: Home Improvement Project Estimator Location: Painesville, Ohio TruBlue of the Western Reserve is a home improvement services company dedicated to p…
Commercial Route Manager (Hiring Immediately)
Description: Ready to take control of your career? Join a team that protects businesses and builds lasting partnerships.Are you a problem-solver who thrives on independence, but loves being part of a…
Senior Structural Engineer
LaBella is currently hiring for a Senior Structural Engineer in our Ohio offices. The Structures Discipline provides structural engineering services with emphasis on new design, repair, and rehabilit…
Enterprise Account Executive - Pursuit, East
Elastic, the Search AI Company, enables everyone to find the answers they need in real time, using all their data, at scale — unleashing the potential of businesses and people. The Elastic Search AI …
RN / REGISTERED NURSE - MED/SURG ONCOLOGY - ROTATING SHIFTS
Why Beebe?: Become part of the Beebe team—an inclusive, mission‑driven organization located in a vibrant coastal community. At Beebe, you’ll build a rewarding career while making a meaningful impact …
Assistant Store Manager - Columbus
Join a dynamic, customer-focused retail team as an Assistant Store Manager in Columbus, Ohio! This is an exciting opportunity for energetic, service-oriented individuals who thrive in a fast-paced, t…
CASHIER & CUSTOMER SERVICE ASSOCIATES
Providing excellent customer service both on the phone and in person. Phone work - answering incoming calls and making outgoing calls to customers for various reasons relating to the showroom busine…
Non CDL Van Driver
$500.00 SIGN-ON BONUS!! Immediate openings for new drivers! Do you enjoy driving? Are you looking for a position where you can make a difference? If so, then this is the opportunity you have been…
Senior People Manager
Orbia Advance Corporation is a Purpose-led company with big aspirations. We are out to advance life around the world while maximizing value to our shareholders, customers and employees. The Company i…
Mobile Maintenance Technician
Job Title: Mobile Maintenance Technician Location: Columbus, OH Employment Type: Full-Time Are you a hands-on problem solver who takes pride in keeping buildings running at their best? W…