Case Manager Assistant, LPN – Bilingual
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Job Description
MedWatch, a population health management company, seeks a bilingual remote Case Manager Assistant/LPN. Coordinating patient care, authorizations, documentation, and provider relationships under RN supervision.
Responsibilities:
- Assist the RN Case Manager with case management functions under direct supervision
- Authorize services and review treatment plans for medical necessity and standards of care
- Communicate with providers, payers, patients, and primary caregivers
- Review medical data and update case management plans
- Contact payers to understand benefit constraints affecting the plan of action
- Verify medical necessity of ordered care and equipment with providers and vendors
- Arrange quality patient care according to patient needs, physician orders, and available benefits
- Evaluate alternative treatment possibilities and prepare cost-benefit analyses when extra-contractual services may be appropriate
- Identify community resources and funding sources to support patient care
- Document case actions and complete all case information in the computer system
- Prepare timely reports for payers for Case Manager review
- Maintain billing in the computer system as appropriate
- Maintain contact with providers and patients across the continuum of care
- Monitor chronic-condition cases through periodic contacts
- Negotiate with providers to maximize available medical benefits
- Make network referrals as appropriate
- Address patient safety or welfare concerns by directing patients or families to resources or notifying authorities in consultation with the Case Manager
- Consult regularly with the Case Manager and inform the Director of Case Management about complaints or issues beyond the assistant's expertise
- Adhere to company policies and participate in the Quality Management Program
Requirements:
- Current, active, and unrestricted Licensed Practical Nurse license or Medical Assistant/Nursing Assistant certification in the current state of practice and residence within the United States or its territories
- 3 years of experience in a specialty field required as an alternative to the preferred 5 years of varied clinical experience
- Basic computer skills
- Strong computer skills and proficiency in Microsoft Office Suite, including Word, Excel, and PowerPoint
- 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
- Fluent English and Spanish, with strong reading and writing abilities in both languages
- Ability to practice within the scope of licensure
- Ability to work in the United States without employer sponsorship
- Dedicated, quiet home workspace
- Licensed Practical Nursing education is preferred
Benefits:
- Paid time off
- Medical insurance
- Dental insurance
- Vision insurance
- Short-term disability
- Long-term disability
- Life insurance
- AD&D insurance
- 401(k) with match
- Critical illness coverage
- Legal plan
- Identity theft coverage
- Pet insurance
- Discount programs
- Bilingual Spanish-speaking pay differential
- Remote work arrangement
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