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Nurse - Case Manager

Software Galaxy Systems, LLC

  • 12 days ago
  • Remote
  • $38–$40 Per Hour
  • Contractor

Highlights

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.

Numbers & Facts

Location (
Remote)
Job TypeContractor
Salary$38–$40 Per Hour
Year Foundednull

Description

  • 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

Job Responsibilities

  • 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

Qualifications

  • Requires an RN with unrestricted active license in Pennsylvania or a compact state.
    3 years 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 involving periods of sitting, talking, 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

Skills

  • Clinical Assessment
  • Patient Assessment
  • Case Management

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