Vacancy Description
Our Client, a Retail Pharmacy company, is looking for a Nurse Case Manager II for their Wayne, MI/Macomb County, MI location. Responsibilities:
+ 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
Requirements:
+ 3 years Clinical practice experience, e.g., hospital setting, alternative care ...
+ 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
Requirements:
+ 3 years Clinical practice experience, e.g., hospital setting, alternative care ...
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