Our Client, a Retail Pharmacy company, is looking for a Nurse Case Manager II for their Lynchburg, 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
- Case Management Certification CCM preferred
Why Should You Apply?
- Health Benefits
- Referral Program
- Excellent growth and advancement opportunities