Nurse Case Manager II Job at SGS Consulting, Remote

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  • SGS Consulting
  • Remote

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.
  • Through the use of clinical tools and 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:

  • Years of 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 involves periods of sitting, talking, and 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 handwritten and computer-generated documents as well as a PC monitor.
  • Typical office working environment with productivity and quality expectations

Education/Experience:

  • AA degree in nursing min; Bachelors preferred; Licensed Registered Nurse

Job Tags

Remote job, Work at office,

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