What are the responsibilities and job description for the Nurse Case Manager II position at Medical Recruitment Strategies?
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. Requires an RN with unrestricted active license
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
