Job Title: Nurse Case Manager II
Job Duration: 3+ Months (Possibilities of extension)
Shift: Mon to Fri, 8 am to 5 pm
Job Location: Philadelphia PA 19019
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
Education:
RN with current unrestricted state licensure in state of PA or a compact license
Associate s of Science in Nursing (ASN) degree and relevant experience in a health care-related field (REQUIRED)
Bachelor s of Science in Nursing (BSN) (PREFERRED)
Case Management Certification CCM preferred
Numbers & Facts
Location
Philadelphia, PA
Skills
Ambulatory Careunmatched
Case Managementunmatched
Certified Case Manager (CCM)unmatched
Clinical Informationunmatched
Compensation and Benefitsunmatched
Computer Skillsunmatched
Corporate Policiesunmatched
Cost Controlunmatched
Healthcareunmatched
Home Careunmatched
Hospitalunmatched
Maintain Complianceunmatched
Managed Careunmatched
Nursingunmatched
Quality Managementunmatched
Registered Nurse (RN)unmatched
Regulationsunmatched
Regulatory Complianceunmatched
Team Playerunmatched
🎯
Be found by employers
5,500+ employers search our resume database daily. Add yours to get found by recruiters looking for candidates like you.
Level up your application
Professional resume templates
Browse dozens of recruiter approved resume templates, layouts and formats. Choose your favorite and make it your own in minutes.