Nurse Case Manager II
Job Responsibilities:
- 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 in Georgia.
- 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.
Skills:
- 2-3 years Clinical practice experience, e.g., hospital setting, alternative care setting such as home health or ambulatory care required.
- 2 years’ Healthcare and/or managed care industry experience.
- Case Management experience required.
Education/Experience:
- RN with current unrestricted compact state licensure with Case Management Certification preferred.
Recommended Jobs
Transportation Assistant
Come be a part of something big! Smart Minds, Cool Jobs and Awesome Rewards! Fueled by innovation, talent and ambition, the Air Force Civilian Service (AFCS) is seeking civilian professionals prepared…
Diesel Mechanic
Skills: ~ Inspect diesel engines for defects or malfunctioning and diagnose problems with the help of computerized diagnostic equipment ~ Perform different routine tasks, like changing oil and …
Certified Pharmacy Technician
In accordance with state and federal regulations, assists the pharmacist, under direct supervision, in the practice of pharmacy. Assists the pharmacist in the performance of other Pharmacy Department…
Business Development Manager
Business Development Manager – Middle Market To Apply Now – email your resume to [email protected] Who: A professional to build and nurture relationships with CFOs, C…
Unarmed Safety Officer
Job Opportunity: Unarmed Safety Officer at Valor Protection Security Agency (VPSA) Join Our Team at Valor Protection Security Agency – Where Excellence Meets Integrity! We are cu…
Integration Manager- Mandarin language requirement
One stop shop or hub for driving all strategy, new development, and performance enhancements for specific set of products. Product manager coordinates among tactical analysts, developers, and function…
Kaleidoscope Afterschool Instructor
*This is a year round open position for ongoing recruitment purposes. ABOUT OUR SCHOOL Atlanta International School (AIS) is a preschool to grade 12 private, non-profit school with language imme…
Interventional Respiratory Therapist
Overview: Experience the advantages of real career change Join Piedmont to move your career in the right direction. Stay for the diverse teams you’ll love, a shared purpose, and schedule flexibili…
Head of Department (HOD/Sr. Mgr.), IT
Overview: We are seeking an experienced and strategic Head of IT Department to join Hyundai MOBIS. This role is responsible for planning, implementing, and optimizing IT infrastructure and core syste…
LPNs NEEDED IN HAMPTON, GA $40-$42 PER HR
JOIN OUR AMAZING TEAM OF NURSES AND PROVIDE CARE IN THE COMFORT OF OUR CLIENTS HOME! SHIFTS TO FIT ANYONE'S AVAILABILITY! Patient has a colostomy bag, SP catheter and receives insulin injections. …