Case Manager Assistant, LPN
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Job Description
Case Manager Assistant supporting RN-led case management for MedWatch, a population health management company. Coordinating healthcare services, reviewing medical necessity, documenting cases, and connecting patients with resources.
Responsibilities:
- Assist the RN Case Manager with case management functions under direct management and supervision
- Authorize services and review treatment plans for medical necessity and standards of care
- Maintain ongoing communication with healthcare team members, providers, payers, patients, and caregivers
- Review medical data and update case management plans
- Contact payer offices to understand benefit constraints affecting patient care plans
- Contact providers and equipment vendors to verify medical necessity
- Arrange quality patient care according to patient needs, physician orders, and available benefits
- Evaluate alternative treatment possibilities and provide cost-benefit analyses for extra-contractual services when appropriate
- Identify community resources and funding sources for patients
- Document case actions and complete case records in the computer system
- Prepare timely reports for payers detailing case actions, results, and ongoing plans
- Maintain billing in the computer system as appropriate
- Maintain contact across the continuum of care and monitor chronic-condition cases
- Negotiate with providers to maximize available medical benefits
- Make network referrals as appropriate
- Address non-medical issues involving patient safety or welfare and refer patients to appropriate resources or authorities
- Consult regularly with the Case Manager and report complaints or issues beyond the assistant's competence
- 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
- License or certification must be valid in the applicant's current state of practice and residence within the United States or its territories
- Licensed Practical Nursing education preferred
- Basic computer skills
- Five years of varied clinical experience preferred, or three years in a specialty field
- Practice within the scope of licensure
- Ability to work in a typical home office environment with prolonged computer sitting
- Hand-eye coordination and manual dexterity sufficient to operate standard office, computer, and phone equipment
- Ability to work in the United States for any employer without sponsorship
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
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