Work Schedule: M-F 8-5 EST
50-75% Travel required
The Case Manager utilizes a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individual’s benefit plan and/or health needs through communication and available resources to promote optimal, cost-effective outcomes.
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 member’s 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:
- Minimum 3 years of experience.
- Must be flexible and adaptable.
- Strong basic computer skills required (Excel filtering, Outlook, email).
- Must be comfortable with home visits, nursing facilities, and hospitals.
Education/Experience:
- RN with current unrestricted state licensure and Case Management Certification/ CCM – preferred
