Case Manager MNR RN
MedWatch•Lake Mary, FL
•Hybrid
About The Position
The Case Manager manages an individual caseload using the Case Management process to meet the needs of MedWatch, LLC customers and consumers. This includes, but is not limited to, authorization of services, review of treatment plans for medical necessity, standards of care, and ongoing communication with all members of the health care team.
Requirements
- Registered Nurse (current active and unrestricted, in state of current practice and residence, within the United States or its territories.)
- Good organizational skills and time management
- Excellent verbal and written communication skills
- Ability to handle difficult situations tactfully and diplomatically.
- Effective problem solving and decision-making skills.
- Strong computer skills with proficiency in MS Office Suite products (Word, Excel, Power Point)
- Independently manages a full case load while maintaining URAC standards.
- Capable of managing complex MNRs with accuracy and consistently scores 90% or greater on monthly audits.
Nice To Haves
- Bachelor's degree in a health-related field
- 7 years of varied clinical experience
Responsibilities
- Manages an individual caseload using the Case Management process.
- Authorizes services.
- Reviews treatment plans for medical necessity and standards of care.
- Maintains ongoing communication with all members of the health care team.
- Reviews all medical data to establish, update, and maintain accountability for a Case Management plan.
- Incorporates contact with providers, payers, the patient, and the patient's primary caregiver.
- Assesses problems and determines goals and actions designed to meet the needs of the patient.
- Documents assessments, goals, and actions into case notes.
- Determines if goals are long term or short term and how the patient can be expected to meet them.
- Includes the action/intervention the Case Manager will take to work towards achieving goals.
- Contacts the payer office to understand benefit constraints that will impact the plan of action.
- Adheres to all company policies as stated in the employee handbook.
- Participates in the Quality Management Program by adhering to all company policies and procedures.
- Identifies opportunities for improvement to ensure quality services are rendered to clients and customers.
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What This Job Offers
Job Type
Full-time
Career Level
Senior
