Location (mandatory): Looking in Toledo Region - Fulton, Wood, Ottawa, and Lucas Counties in OH state
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:
- 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’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:
- 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’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.
Education/Experience:
- RN with current unrestricted state licensure
- Case Management Certification/ CCM – preferred
