*Nurse Case Manager II - OHIO

Ohio, United States

Job Title

Address

Field-Ohio (Field) (OH001F)

Job Description

Conducts comprehensive assessments of referred member's needs and eligibility using clinical tools and information review.
Evaluates member's benefit plan and available programs/services to determine case resolution approach.
Interprets applicable criteria, guidelines, policies, procedures, and regulatory standards to ensure benefit administration.
Utilizes case management and quality management processes in compliance with regulatory and accreditation standards.
Provides advocacy and facilitates options to meet health needs and promote cost-effective outcomes.

Critical Information

Work hours: Monday-Friday 8-5 pm EST
Remote: Fully remote (never coming onsite)
Job duration: Not specified
Environment: Office-based with sedentary work involving sitting, talking, listening, and computer use
Work may include visiting facilities and patients' homes in the Ohio area

Education/Licenses Needed