Nurse Case Manager

Nurse Case Manager

  Not Disclosed

  Columbus, OH

  2.5 Months

  Not Disclosed

  Not Disclosed

  Healthcare

Job Description

Description:

We are seeking self-motivated, energetic, detail oriented, highly organized, tech-savvy Registered Nurses to join our Case Management team. 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. Through the use of 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 the client 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 take into account 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 cases 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. 

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

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 members 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

Required Qualifications :
Active OH RN License - compact license
3+ years of clinical experience

Preferred Qualifications :
Home Health preferred
Computer Skills (Microsoft Office such as: Word, Excel, and outlook)

Education:
Associate's Degree or higher Registered Nurse
Case Management Certification CCM preferred
RN with current unrestricted state licensure

Experience:
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
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

Candidate Profile:
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.

Notes:
Monday - Friday 8am-5pm
Onsite as needed
Travel required: 50%, may vary based on business needs.
Our organization promotes autonomy through a Monday-Friday working schedule, paid holidays, and flexibility as you coordinate the care of your members.