Case Manager I

Healthcare Management Administrators•Bellevue, WA

15h•$85,000 - $99,000•Hybrid

About The Position

HMA is the premier third-party health plan administrator across the PNW and beyond. We relentlessly deliver on our promise to provide medium to large-size employers with customized health plans. We offer various high-quality, affordable healthcare plan options supported with best-in-class customer service. We are proud to say that for four years, HMA has been chosen as a ‘Washington’s Best Workplaces’ by our Staff and PSBJ™. Our vision, ‘Proving What’s Possible in Healthcare™,’ and our values, People First!, Be Extraordinary, Work Courageously, Own It, and Win Together, shape our culture, influence our decisions, and drive our results. What we are looking for: We are always searching for unique people to diversify our team. We only hire people that care deeply about others, thrive in evolving environments, gain satisfaction from being part of a team, are motivated by tackling complex challenges, are courageous enough to share ideas, action-oriented, resilient, and results-driven. What you can expect: You can expect an inclusive, flexible, and fun culture, comprehensive salary, pay transparency, benefits, and time off package with plenty of personal development and growth opportunities. If you are looking for meaningful work, a clear purpose, high standards, work/life balance, and the ability to contribute to something important, find out more about us at: https://www.accesshma.com/ How YOU will make a Difference: The Case Manager provides holistic primary Care Management for all client groups including Medical and Managed Behavioral Health services, monitoring of member utilization and claim patterns and ongoing case management for complex care. Case Managers collaborate with external entities such as Brokers, Group Contacts, and Stop Loss supports to provide updated information on case specifics within HIPAA regulations. What YOU will do: The Case Manager Nurse demonstrates skill in core nursing processing including assessment, planning, implementation, coordination, monitoring and evaluation of proposed treatment plans. Provide ongoing review management of treatment progress as needed to provide personalized support and care coordination for complex, catastrophic or ongoing chronic medical conditions. Evaluates services requested to meet an individual’s health care needs, with the goal to provide personalized management to promote and ensure continuity of care coordination. Perform Utilization Management and apply first the terms of the SPD (Summary Plan Description), considering any benefit limitations/exclusions and PPO status of requesting provider/facility. Reviews are conducted using approved criteria for appropriateness of services, setting/level of care and length of stay.

Requirements

Current Baccalaureate prepared (Preferred) in Nursing or Community/Public Health
1-3+ years of clinical nursing experience
Active Certification or RN clinical license, as applicable to the degree
Strong experience in clinical practice with diverse diagnoses
Developing leadership skills
Problem solving and critical thinking skills
Knowledge of Case Management and Utilization Review processes
Excellent, client-facing verbal and written communication skills
Ability to be self-motivated and self-directed
Enjoys the pace and rhythm of a deadline-oriented environment with strong prioritization skill sets
Behavioral health experience preferred
Proficiency with Microsoft Office applications (Outlook, Word, DOSS)

Nice To Haves

Baccalaureate prepared in Nursing or Community/Public Health

Responsibilities

Provides holistic primary Care Management for all client groups including Medical and Managed Behavioral Health services, monitoring of member utilization and claim patterns and ongoing case management for complex care.
Collaborates with external entities such as Brokers, Group Contacts, and Stop Loss supports to provide updated information on case specifics within HIPAA regulations.
Demonstrates skill in core nursing processing including assessment, planning, implementation, coordination, monitoring and evaluation of proposed treatment plans.
Provide ongoing review management of treatment progress as needed to provide personalized support and care coordination for complex, catastrophic or ongoing chronic medical conditions.
Evaluates services requested to meet an individual’s health care needs, with the goal to provide personalized management to promote and ensure continuity of care coordination.
Perform Utilization Management and apply first the terms of the SPD (Summary Plan Description), considering any benefit limitations/exclusions and PPO status of requesting provider/facility.
Reviews are conducted using approved criteria for appropriateness of services, setting/level of care and length of stay.