Nurse Case Manager II - US Tech Solutions, Inc.

Position Summary: Travel within Wayne and Macomb county. 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 members 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:

· 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

· CCM preferred

Skills: