Nurse Case Manager RN

3 weeks ago

Cincinnati, United States Western and Southern Financial Group Full time
Job DescriptionJob Description

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:

·       Utilize 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.

·       Perform 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.

·       Assist members (associates, retirees, and dependents) in navigating the healthcare landscape and optimizing benefit plan utilization by identifying opportunities to promote quality healthcare. 

·       Monitor 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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