Nurse Case Manager II - Toledo OH

SGS Consulting
Ohio

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
Posted 2025-11-14

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