Nurse Case Manager II

SGS Consulting; Atlanta (GA); On-site; USD 65,000 - 90,000; Full time

Job summary

SGS Consulting in Atlanta, GA is seeking a Case Manager who will use a collaborative process to assess, plan, facilitate, and advocate for options and services to meet an individual's health needs and benefit plan. The role requires an RN licensed without restrictions in Georgia, with Case Management Certification preferred.

The ideal candidate has 2–3 years of clinical practice experience and 2 years in healthcare/ managed care, plus prior case management exposure to ensure compliant,

Qualifications

• 2–3 years clinical practice experience (hospital or similar).
• 2 years healthcare/managed care industry experience.
• Case management experience required.

Responsibilities

• Assess, plan, facilitate, and advocate for member benefits and health needs.
• Analyze eligibility and determine approaches to case resolution.
• Ensure regulatory compliance with standards and company policies.

Skills

Clinical practice

Case Management

Healthcare industry experience

Education

RN licensure

Case Management Certification preferred

Job description

Job Responsibilities

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 in Georgia.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.

Skills

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.Case Management experience required.

Education/Experience

RN with current unrestricted compact state licensure with Case Management Certification preferred.