Job Description
Job Description
Looking in Toledo Region -Fulton, Wood, Ottawa, and Lucas Counties.
Description:
The Case Manager utilizes acollaborative process of assessment, planning, facilitation and advocacy foroptions and services to meet an individuals benefit plan and/or health needsthrough communication and available resources to promote optimal, cost-effectiveoutcomes. Requires an RN with unrestricted active license
Through the use of clinicaltools and information/data review, conducts comprehensive assessments ofreferred member\'s needs/eligibility and determines approach to case resolutionand/or meeting needs by evaluating member\'s benefit plan and available internaland external programs/services Application and/or interpretation ofapplicable criteria and guidelines, standardized case management plans,policies, procedures, and regulatory standards while assessing benefits and/ormembers needs to ensure appropriate administration of benefits Utilizes casemanagement and quality management processes in compliance with regulatory andaccreditation guidelines and company policies and procedures
Duties
Through the use of clinicaltools and information/data review, conducts comprehensive assessments ofreferred member\'s needs/eligibility and determines approach to case resolutionand/or meeting needs by evaluating member\'s benefit plan and available internaland external programs/services
Application and/orinterpretation of applicable criteria and guidelines, standardized casemanagement plans, policies, procedures, and regulatory standards whileassessing benefits and/or members needs to ensure appropriate administrationof benefits
Utilizes case management andquality management processes in compliance with regulatory and accreditationguidelines and company policies and procedures
Experience
3 years Clinical practiceexperience, e.g., hospital setting, alternative care setting such as homehealth or ambulatory care required.
Healthcare and/or managed careindustry experience.
Case Management experiencepreferred-- Position requires proficiency with computer skills which includesnavigating multiple systems and keyboarding
Effective communicationskills, both verbal and written.
Ability to multitask,prioritize and effectively adapt to a fast paced changing environment
Sedentary work involvingperiods of sitting, talking, listening. Work requires sitting for extendedperiods, talking on the telephone and typing on the computer.
Work requires the ability toperform close inspection of hand written and computer generated documents aswell as a PC monitor.
See members in their home anddocumentation from home office.
Position Summary
The Case Manager utilizes acollaborative process of assessment, planning, facilitation and advocacy foroptions and services to meet an individuals benefit plan and/or health needsthrough communication and available resources to promote optimal, cost-effectiveoutcomes.
Requires an RN withunrestricted active license
Education
RN with current unrestrictedstate licensure.
Preferred case managementexperience
What days & hours will theperson work in this position List training hours, if different.
M-F 8-5