Case Management Nurse
4 weeks ago
Western and Southern Financial Group is in search of an experienced Registered Nurse to join the team in Cincinnati, Ohio
Position: Manage Care RN (Case Management)
Location: 400 Broadway, Cincinnati, Ohio 45202
Shift: 8am – 5pm
Pay: Starting at $83,000 and increases with experience
Job Description:
- clinical experience and appropriate clinical criteria and guidelines, along with Plan provisions, in monitoring, evaluating, and coordinating both inpatient and outpatient medical care to promote quality outcomes at reasonable costs.
- prospective and concurrent utilization reviews to determine medical necessity for inpatient admission, inpatient continued stay and selected outpatient services to ensure medically appropriate, high quality and cost-effective care and for most efficient utilization of third-party services.
- members (associates, retirees, and dependents) in navigating the healthcare landscape and optimizing benefit plan utilization by identifying opportunities to promote quality healthcare.
- potential high-cost claims for early intervention with case management and retrospective reviews to assure appropriate and cost effectiveness.
Please submit your resume for immediate consideration
#DP
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