Nurse Case Manager I

International Medical Group•Indianapolis, IN

3d•Hybrid

About The Position

As one of the world's top International Medical Insurance companies, IMG helps individuals and companies of all sizes. Every second of every day, vacationers, those working or living abroad for short or extended periods, people traveling frequently between countries, and those who maintain multiple countries of residence use our products to give themselves global peace of mind®. We are looking to grow our teams with people who share our energy and enthusiasm for creating the best experience for travelers.

Requirements

RN License -- Must have an active RN license in good standing in Indiana.
Qualified candidates must be legally authorized to be employed in the United States. IMG will not be providing sponsorship for employment visa status (e.g., H-1B or TN status) for this position.
Current and active Nursing license – Registered Nurse
Minimum two years acute hospital-based experience providing direct patient care
Good computer skills including familiarity with the Internet, Word and Excel.

Nice To Haves

B.S.N. Preferred
Minimum two years utilization review with a managed care or insurance company
Proficient verbal and written communication skills in a foreign language preferred
Excellent computer skills, including database knowledge.
Experience auditing medical charts against itemized medical bills

Responsibilities

Perform Certifications, Concurrent Reviews, Retrospective Reviews, and Medical Evacuations/Repatriations including inpatient and outpatient management of assistance cases.
Knowledge of the Non-certification process and Appeals process including logs and time frames.
Participate in the on call rotation schedule.
The provision of telephone and email based pre travel advice.
Direct and/or re-direct members to in-network providers.
Negotiate discounts with out of network providers.
Direct healthcare team members to utilize alternative care settings when appropriate.
Identify potential large case management cases by diagnosis, dollar amount and/or high utilization of medical services and refer those identified for large case management.
Document information and status in case management systems and document.
Prepare precertification and/or case management reports as needed.
Use good judgment when evaluating medical cases and confer with Medical Director when appropriate.
Communicate with other members of team as needed, and ensure that information is shared appropriately.
Maintain confidentiality and privacy of all protected health information.
Continue education through relevant reading materials, online courses and/or seminars.
Support and participate in Quality Management activities.
Utilize clinical support tools as indicated.
Maintain a working knowledge of the any applicable state or federal regulations as appropriate for job duties.
Report/document complaints when/if received.
Any other job duties or tasks as assigned.