Job Description

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.

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