Nurse Case Manager II

Duration: _____ Months/__06 Months__weeks

Job Overview: My Care of Ohio hiring for care management in one of our counties we serve, Franklin, Delaware, Madison, Pickaway, Union County.

We are seeking self-motivated, energetic, detail oriented, highly organized, tech-savvy Registered Nurses to join our Case Management team. Our organization promotes autonomy through a Monday-Friday working schedule 8am-5pm as you coordinate the care of your members. Nurse Case Manager is responsible for telephonically and/or face to face assessing, planning, implementing, and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate the member’s overall wellness. Develops a proactive course of action to address issues presented to enhance the short and long-term outcomes as well as opportunities to enhance a member’s overall wellness through integration. Services strategies policies and programs are comprised of network management and clinical coverage policies. Our Care Managers are frontline advocates for members who cannot advocate for themselves. They are responsible for assessing, planning, implementing, and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate the member’s overall wellness. Using clinical tools and information/data review, conducts an evaluation of member's needs and benefit plan eligibility and facilitates integrative functions as well as smooth transition to Aetna programs and plans. Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and barriers and address complex health and social indicators which impact care planning and resolution of member issues. Assessments consider information from various sources to address all conditions including co-morbid and multiple diagnoses that impact functionality. Reviews prior claims to address potential impact on current case management and eligibility. Assessments include the member’s level of work capacity and related restrictions/limitations. Using a holistic approach assess the need for a referral to clinical resources for assistance in g functionality. Consults with supervisor and others in overcoming barriers in meeting goals and objectives, presents case at case conferences for multidisciplinary focus to benefit overall claim management. Utilizes case management processes in compliance with regulatory and company policies and procedures. Utilizes interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversation.

Skills: Must Have

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.

Experience:

• 2 years of clinical experience with active RN license free of restrictions.

Minimum Qualification:

• Requires an RN with unrestricted active license.
• 2 years of clinical experience with active RN license free of restrictions.

Experience Required: 01-02 Years.

Shift: Mon – Fri, 01st Shift and 40 hrs.