Job Description

Description:

Looking in Toledo region. Fulton, Wood, Ottawa, and Lucas Counties.

Qualification

Duties :

• My Care of Ohio hiring for temporary care management in one of our counties we serve, Fulon, Wood, Ottowa, and Lucas Counties.
• We are seeking self-motivated, energetic, detail oriented, highly organized, tech-savvy Registered Nurses to join our Case Management team.
• Our organization promotes autonomy through a Monday-Friday working schedule, paid holidays, and flexibility as you coordinate the care of your members.
• Nurse Case Manager is responsible for telephonically and/or face to face assessing, planning, implementing and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate the member’s overall wellness.
• Develops a proactive course of action to address issues presented to enhance the short and long-term outcomes as well as opportunities to enhance a member’s overall wellness through integration.
• Services strategies policies and programs are comprised of network management and clinical coverage policies.
• Our Care Managers are frontline advocates for members who cannot advocate for themselves.
• They are responsible for assessing, planning, implementing, and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate the member’s overall wellness.
• Through the use of clinical tools and information/data review, conducts an evaluation of member's needs and benefit plan eligibility and facilitates integrative functions as well as smooth transition to Aetna programs and plans.
• Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and barriers and address complex health and social indicators which impact care planning and resolution of member issues.
• Assessments take into account information from various sources to address all conditions including co-morbid and multiple diagnoses that impact functionality.
• Reviews prior claims to address potential impact on current case management and eligibility.
• Assessments include the member’s level of work capacity and related restrictions/limitations.
• Using a holistic approach assess the need for a referral to clinical resources for assistance in g functionality.
• Consults with supervisor and others in overcoming barriers in meeting goals and objectives, presents cases at case conferences for multidisciplinary focus to benefit overall claim management.
• Utilizes case management processes in compliance with regulatory and company policies and procedures.
• Utilizes interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversation.

Experience :

Required Qualifications :

• P-Active RN License
• 2+ years of clinical experience

Preferred Qualifications:

• Home Health preferred
• Computer Skills (Microsoft office such as: Word, Excel, and outlook)

Education :

• RN Associate's Degree or higher

Education :

• RN with current unrestricted state licensure.
• Case Management Certification, CCM preferred

What days & hours will the person work in this position? List training hours, if different. : M-F 8-5

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