Case Manager / RN

MedWatch • FL

90d • $72,000 - $81,000

About The Position

The Case Manager manages an individual caseload using the case management process in order to meet the needs of the 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. This is a remote/work-from-home position.

Requirements

• Current active and unrestricted Registered Nurse license in the state of current practice and residence within the United States or its territories.
• 7 years of varied clinical experience preferred.

Nice To Haves

• Bachelor’s degree in a health-related field preferred.

Responsibilities

• Practice within the scope of licensure as a Registered Nurse.
• Review all medical data to establish, update, and maintain accountability for a case management plan.
• Assess problems and determine goals and actions designed to meet the needs of the patient and document into the case notes.
• Determine if goals are long term or short term and how the patient can be expected to meet those goals.
• Contact payer office to understand any benefit constraints impacting the plan of action.
• Contact medical care providers and equipment vendors to verify medical necessity of care or equipment ordered.
• Make care arrangements for quality patient care according to patient needs, physician’s orders, and available benefits.
• Work with the Case Management Assistant to manage case management files and provide input in their performance evaluation.
• Maintain responsibility for the Case Management file.
• Be aware of alternative treatment possibilities and provide cost-benefit analysis for extra-contractual services if necessary.
• Familiarize with community resources and funding sources to assist patients.
• Document case actions for each patient in the computer system and prepare timely reports to the payer.
• Maintain billing as appropriate in the computer system.
• Continue contact with providers and patients across the continuum of care.
• Negotiate with providers to maximize medical benefits available to the patient.
• Act upon awareness of non-medical issues affecting patient safety or welfare.
• Consult with the CM supervisor regularly and keep them informed of any complaints or issues.
• Adhere to all company policies as stated in the employee handbook.
• Obtain a URAC-recognized certification in Case Management within 3 years of hire.
• Participate in the Quality Management Program by identifying opportunities for improvement.

Benefits

• Eligible for a bonus program.
• Salary range from $72,000 to $81,000 annually.

What This Job Offers

• Education Level: Bachelor's degree
• Number of Employees: 101-250 employees