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Conducts comprehensive assessments of referred members' 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.
Applies and interprets 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.
Critical Information
Requires 3 years of clinical practice experience, including hospital or alternative care settings.
Must have proficiency with computer skills, including navigating multiple systems and keyboarding.
Effective communication skills, both verbal and written, are required.
Sedentary work is involved, with periods of sitting, talking, listening, and typing on the computer.
Education/Licenses Needed:
RN with current, unrestricted state licensure.
Case Management Certification (CCM) is preferred.
Benefits
Benefits are available to full-time employees after 90 days of employment.
A 401(k) with company match is available to full-time employees with 1 year of service on our eligibility dates.
This is an AI-formatted job description; therefore, this does not remove human decision-making.
Verify with a Recruiter or Staffing Manager if any section is missing.
Seniority level
Mid-Senior level
Employment type
Full-time
Job function
Health Care Provider
Industries
Staffing and Recruiting
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