Nurse Case Manager

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.
• RN, LCSW, or LCPC with current unrestricted IL state licensure REQUIRED

Experience

• Minimum 3-5 years clinical practical experience preferred
• Minimum 2-3 years Care Management, discharge planning and/or home health care coordination experience preferred
• Confidence working at home/independent thinker, using tools to collaborate and connect with teams virtually
• Excellent analytical and problem-solving skills
• Effective communications, organizational, and interpersonal skills.
• Ability to work independently Effective computer skills including navigating multiple systems and keyboarding Demonstrates proficiency with standard corporate software applications, including MS Word, Excel, Outlook, and PowerPoint, as well as some special proprietary applications

Education : RN, LCSW, or LCPC with current unrestricted state licensure in IL. REQUIRED