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Responsibilities
Will consider submissions outside of FL if:
* Must have a compact license.
* Must reside in the EST time zone.
They are required to have a private office space free of any distractions due to HIPAA compliance.
Required:
* Must have experience working in a remote position previously.
* Must have case management experience.
Through the use of clinical tools and information and data review, conducts comprehensive assessments of referred members’ needs and eligibility. Determines the approach to case resolution and/or meeting needs by evaluating the member’s benefit plan and available internal and external programs and services. Applies and/or interprets applicable criteria and guidelines, standardized case management plans, policies, procedures, and regulatory standards while assessing benefits and/or member 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.
Duties:
* Proficiency with computer skills, including 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, and listening.
* Work requires sitting for extended periods, talking on the telephone, and typing on the computer.
* Ability to perform close inspection of handwritten and computer-generated documents, as well as a PC monitor.
* Typical office working environment with defined productivity and quality expectations.
Experience:
* Two to three years of clinical practice experience, for example, in a hospital setting or alternative care settings such as home health or ambulatory care.
* Two years of healthcare and/or managed care industry experience.
* Case management experience required.
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 and cost-effective outcomes.
Requirements:
* Registered Nurse (RN) with an unrestricted active COMPACT state license.
* Case Management Certification preferred.
Work schedule:
* Monday to Friday, 8:00 a.m. to 5:00 p.m., Eastern Time Zone.
This job post is closed.