Nurse Case Manager II

Our client•Wayne and Macomb Counties, MI

3d•Onsite

About The Position

Our client, a IT Services and Consulting company, is looking for a Nurse Case Manager II for their Wayne and Macomb Counties, MI location. 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 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.

Requirements

RN with unrestricted active license
Verifiable High School Diploma or GED
3 years clinical practice experience, e.g., hospital setting, alternative care setting such as home health or ambulatory care
Healthcare and/or managed care industry experience
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

Nice To Haves

Case Management experience preferred
Case Management Certification CCM preferred

Responsibilities

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.
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.
Applies and/or interprets 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.