Nurse Case Manager II

Duties: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. 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 ID: 26-79794
 
Position Type: Fulltime
 
Location:Remote

Work Type: Remote
 
Est. Pay Range: $34.35/hr. To $37.00/hr.  all-inclusive on W2

Position Summary:
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.
 
Duties:

• 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

 
Experience:

• 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 hand written and computer generated documents as well as a PC monitor.
• Typical office working environment with productivity and quality expectations.

 
Education:

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

Employee Benefits:
At LanceSoft, full time regular employees who work a minimum of 30 hours a week or more are entitled to the following benefits:
Four options of medical Insurance
Dental and Vision Insurance
401k Contributions
Critical Illness Insurance
Voluntary Permanent Life Insurance
Accident Insurance
Other Employee Perks
 
LanceSoft is a certified Minority Business Enterprise (MBE) and an equal opportunity employer. We prohibit discrimination and harassment of any kind based on race, color, sex, religion, sexual orientation, national origin, disability, genetic information, pregnancy, or any other protected characteristic as outlined by federal, state, or local laws.
This policy applies to all employment practices within our organization, including hiring, recruiting, promotion, termination, layoff, recall, leave of absence, compensation, benefits, training, and apprenticeship. LanceSoft makes hiring decisions based solely on qualifications, merit, and business needs at the time.