Nurse Case Manager

VIVA USA Inc; United States; À distance; USD 65 000 - 90 000; Plein temps

Résumé du poste

VIVA USA Inc. is seeking a Case Manager who will assess, plan, facilitate and advocate for services to meet a member's health needs through collaboration and available resources. Travel to members' homes will be required 50-75% of the time, with work-from-home between visits.

The role requires an RN with an unrestricted license and experience in case management, healthcare or managed care. You should be organized, independent, and proficient with computer systems.

Qualifications

• 3 years clinical practice experience (hospital or similar)
• Healthcare and/or managed care industry experience
• Case management experience preferred
• Effective verbal and written communication skills
• Ability to multitask and adapt to a fast-paced environment
• Proficient computer skills and navigating multiple systems

Responsabilités

• Assess referred member needs/eligibility and determine a plan by evaluating benefit plans and available programs/services
• Apply criteria, guidelines, and regulatory standards to ensure appropriate benefits administration
• Utilize case management and quality management processes in compliance with company policies and regulatory standards

Connaissances

Case management

Communication

Organizational skills

Independent work

Multitasking

Formation

RN licensure

Description du poste

Fully remote (never coming onsite)

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.

Experience with case management.

Position will require travel to members' homes up to 50-75% travel. Must live near areas listed due to travel requirement and will work at home in between visits. We want someone who is organized, efficient, and can work independently.

• -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

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

Experience

• 3 years Clinical practice experience, e.g., hospital setting, alternative care setting such as home health or ambulatory care required.
• Healthcare and/or managed care industry experience.
• Case Management experience preferred-- Position requires proficiency with computer skills which includes 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, listening. Work requires sitting for extended periods, talking on the telephone and typing on the computer.
• Work requires the ability to perform close inspection of hand written and computer generated documents as well as a PC monitor.
• Typical office working environment with productivity and quality expectations?
• Requires an RN with unrestricted active license

Education

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

Notes

8am to 5pm Ct Mon-Fr

Fully remote (never coming onsite)

safety sensitive

VIVA is an equal opportunity employer. All qualified applicants have an equal opportunity for placement, and all employees have an equal opportunity to develop on the job. This means that VIVA will not discriminate against any employee or qualified applicant on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status