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Job description
Description
Job Title
Nurse Case Manager 2
Location
Camden, New Jersey
Position Description
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. Will be expected to travel to various hospital facilities to meet with members and hospital staff. Will collaborate with the assigned care manager to report visit findings.
Roles Responsibilities
• Conduct comprehensive assessments using clinical tools and data review
• Evaluate member eligibility, benefit plans, and available services
• Develop and implement case management plans
• Ensure compliance with regulatory guidelines and company policies
• Coordinate care across internal and external healthcare services
• Maintain accurate documentation and quality standards
Skills
• Active, unrestricted RN license in New Jersey (Compact License required)
• Minimum 3 years of clinical experience (hospital, home health, or ambulatory care)
• Case Management experience preferred
Worksite address
trenton, NJ, 08628, US
Who can apply
Review the original listing for work authorization, qualifications and employer requirements.