Job Description

Job ID: 25-312920
Job Title: 'Nurse Case Manager II'
Position Type: Full-Time Contract Role
Location: Toledo region, OH. Lucas, Fulton, Ottawa and Wood Counties
Work Type: 50% Travel within the county and the rest work from home
Est. Pay Range: $32.00/Hour to $35.95/Hour on W2 (USD)
Schedule: Monday-Friday, 8 am to 5 pm EST
Looking in Toledo region. Lucas, Fulton, Ottawa and Wood Counties.
Duties:
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
Experience:
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. Proficient in MS Office Suite (TEAMS, Word, Excel, Outlook)
Effective communication skills, both verbal and written.
Ability to multitask, prioritize and effectively adapt to a fast paced changing environment
Sedentary work involving periods of sitting, talking, listening. Work requires sitting for extended periods, talking on the telephone and typing on the computer.
Work requires the ability to perform close inspection of hand written and computer generated documents as well as a PC monitor.
Typical office working environment with productivity and quality expectations. Must show that they are able to get their work done in an efficient manner. Their work will be audited.
Position Summary:
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.
Requires an RN with unrestricted active license
RN with current unrestricted state licensure from Ohio.
Case Management Certification CCM preferred

Skills Required