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
Registered Private Wealth Client Associate
Merrill Wealth Management is a leading provider of comprehensive wealth management and investment products and services for individuals, companies, and institutions. Merrill Wealth Management i…
Kitchen Team Member
Description Our kitchen staff work in a fast paced, high energy environment. The responsibility of our kitchen staff is to produce the highest quality food with precision and accuracy, continua…
Remote Registered Dietitian or CNS - Flexible Hours, Work from Anywhere
Location: Fully Remote Schedule: Flexible Compensation: Up to $85 per hour Job Type: Full-time, Part-time About the Role We’re looking for entrepreneurial, empathetic Registered …
Process Technician
Job Title: Process Technician Reports To: Injection Molding Manager Location: Canton, OH, USA Department: Injection Molding Job Summary As a Process Technician at AmbaFlex , you wil…
Travel Radiology Nuclear Medicine Tech Job
Job Overview TLC Nursing Associates, Inc. is seeking a skilled Nuclear Medicine Technologist to prepare and administer radiopharmaceuticals, perform high?quality diagnostic and therapeutic imag…
Maintenance Operations Manager
A respected law firm client of ours is hiring a Litigation Legal Assistant for its West Palm Beach office. This is a full-time, onsite position supporting attorneys and paralegals with day-to-day lit…
Project Engineer
Project Engineer THP Limited, Inc. is adding a full-time structural design engineer with 0-3 years experience who wants to start their career in a challenging and rewarding work environment. Thi…
Senior Preconstruction and Estimating Manager, Power Market
Senior Preconstruction and Estimating Manager, Power Market Location: Atlanta, GA, US, 30339North Charleston, SC, US, 29405Lincoln, NE, USMinot, ND, US, 58701Nashville, TN, US, 37210Detroi…
Maintenance Technician
Overview We’re seeking a skilled Multi-Craft Maintenance Technician to join a world-class manufacturing operation producing consumer chemical and body products. This facility combines chemical bat…