Nurse Case Manager II

Title: Registered Nurse Case Manager

Location: Toledo OH 43537

Duration: 3 months

Key Responsibilities

• Conduct comprehensive assessments of referred members to evaluate eligibility, care needs, and available services.
• Interpret and apply clinical criteria, benefit guidelines, and standardized case management protocols.
• Develop and implement individualized care plans based on members' benefit plans and internal/external resources.
• Ensure appropriate use of benefits while adhering to policies, procedures, regulatory standards, and accreditation guidelines.
• Apply case management and quality management processes to improve care delivery and outcomes.

Qualifications

Education & Licensure

• Active, unrestricted RN license required.
• CCM (Certified Case Manager) preferred.

Experience

• Minimum of 3 years of clinical experience (e.g., hospital, home health, or ambulatory care).
• Experience in healthcare and/or managed care settings.
• Previous case management experience preferred.

• Conduct comprehensive assessments of referred members to evaluate eligibility, care needs, and available services.
• Interpret and apply clinical criteria, benefit guidelines, and standardized case management protocols.
• Develop and implement individualized care plans based on members' benefit plans and internal/external resources.
• Ensure appropriate use of benefits while adhering to policies, procedures, regulatory standards, and accreditation guidelines.
• Apply case management and quality management processes to improve care delivery and outcomes.

• Active, unrestricted RN license required.
• CCM (Certified Case Manager) preferred.

• Minimum of 3 years of clinical experience (e.g., hospital, home health, or ambulatory care).
• Experience in healthcare and/or managed care settings.
• Previous case management experience preferred.