Case Manager (Specialty) / RN

MedWatch•Lake Mary, FL

1d•$72,000 - $81,000•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. The Registered Nurse Case Manager will practice within the scope of his/her licensure. The incumbent may be responsible for duties or responsibilities that are not listed in this job description. Duties and responsibilities may change at any time with or without notice.

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 into the Case Management plan.
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 those goals.
Includes the action/intervention the Case Manager will take to work towards achieving those goals.
Contacts the payer office to understand any 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.