Nurse Case Manager II - Toledo OH
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
E-Commerce Coordinator, Sylvania, Ohio
Join a well-established, community-focused retail business in Westerville, Ohio as a part-time E-Commerce Coordinator. This role offers the opportunity to be an integral part of a collaborative team,…
ASST STORE MGR in STRONGSVILLE, OH S23637 (Strongsville)
Work Where You Matter At Dollar General, our mission is Serving Others! We value each and every one of our employees. Whether you are looking to launch a new career in one of our many convenient S…
FT Customer Service Representative
Full - Time: Starting at $12 per hour. Monday-Thursday 3pm-11pm Friday 1pm-9pm Hourly increases at 180 days, 1 year and every 6 months, after the first year, based on anniversary date. At Na…
Harley-Davidson Motorcycle Technician
Farrow isn't just a bike shop. We're a family eager to share our passion, expertise, ideas, and stories with every unique individual that walks through the door. We offer more than bikes, parts, an…
Facility and Building Manager
Job Description Job Description Job Summary: The Facility and Building Manager is responsible for the day-to-day management of the company's facilities. This includes overseeing maintenance an…
Data Engineer -Columbus, OH (5 Days Onsite)
Job Title: Data Engineer Location: Columbus, OH (5 Days Onsite) Employment Type: W2 Only (Local/Nearby Candidates Preferred) Experience Level: 5+ Years Team: Privileged Access Manageme…
Technical Analyst 5-Support
Job Description As a member of the Support organization, your focus is to deliver post-sales support and solutions to the Oracle customer base while serving as an advocate for customer needs. This…