Nurse Case Manager II

Our Client, a Retail Pharmacy company, is looking for a Nurse Case Manager II for their Richmond, VA location.

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
• Will be expected to travel to various hospital faciliteis to meet with members and hospital staff.
• Will collaborate with the assigned case manager to report visit finidngs.

Requirements:

• 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
• RN with current unrestricted state licensure.
• Case Management Certification CCM preferred

Why Should You Apply?

• Health Benefits
• Referral Program
• Excellent growth and advancement opportunities