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Posted 4 months ago
Requirements and responsibilities
Will consider submissions outside of GA if:
* They have a compact license.
* They must reside in the EST time zone and in USA.
They are required to have a private office space free of any distractions due to HIPPAA Compliance.
Experience:
* 2-3 years clinical practice experience, e.g., hospital setting, alternative care setting such as home health or ambulatory care, required.
* 2 years healthcare and/or managed care industry experience.
Required:
* Must have experience working a remote position previously.
* Must have case management experience.
* Requires an RN with unrestricted active license in Georgia.
Preferred:
* Case Management Certification CCM.
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.
Through the use of clinical tools and information/data review, the Case Manager 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 is required while assessing benefits and/or member's needs to ensure appropriate administration of benefits.
The Case Manager utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.
Optionally, you can add more information later (benefits, pre-screening questions, etc.)