Location (mandatory): Looking in Toledo Region - Fulton, Wood, Ottawa, and Lucas Counties in Oh State.
Shift: Monday - Friday 8:00 - 5:00 PM EST
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:
- 03 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
- Through the use of clinical tools and 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
- Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures
- 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 ;
Skills:
- Looking in Toledo Region - Fulton, Wood, Ottawa, and Lucas Counties.
Education/Experience:
- Required: RN with current unrestricted state licensure and Case Management Certification preferred
