Case Manager, RN – Licensed in all 50 states
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Job Description
Registered Nurse Case Manager managing patient caseloads for MedWatch’s population health management services. Coordinating medically necessary care, benefits, providers, and payer communications remotely.
Responsibilities:
- Manage an individual caseload using the case management process
- 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 establish, update, and maintain case management plans
- Assess patient problems, determine goals and actions, and document case notes
- Evaluate benefit constraints and coordinate with payer offices
- 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
- Manage case management files with the Case Management Assistant and maintain responsibility for the case management file
- Identify alternative treatments and provide cost-benefit analyses for extra-contractual services when appropriate
- Use community resources and funding sources to support patient care and conserve benefit-plan dollars
- Document all case actions in the computer system and maintain billing
- Prepare timely reports to payers detailing case actions, results, and continuing plans
- Maintain contact with providers and patients across the continuum of care
- Keep chronic-condition cases open for periodic clinical-status and medical-needs contacts
- Negotiate with providers and make network referrals
- Address non-medical issues affecting patient safety or welfare and direct patients or families to appropriate resources or authorities
- Consult regularly with the CM supervisor regarding complaints and issues outside the case manager’s expertise
- Participate in the Quality Management Program and identify service-improvement opportunities
- Adhere to company policies and procedures
Requirements:
- Current, active, and unrestricted Registered Nurse license in the state of current practice and residence within the United States or its territories
- Registered Nurse licensed in all 50 states, including non-compact states
- R.N. credential
- Bachelor’s degree in a health-related field preferred
- 7 years of varied clinical experience preferred
- Must possess a URAC-recognized certification in Case Management within 3 years of hire
- Practice within the scope of nursing licensure
- Ability to work in a home office 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 coverage
- 401(k) with match
- Critical illness coverage
- Legal plan
- Identity theft coverage
- Pet insurance
- Discount programs
- MedWatch reimburses for renewals of RN licenses outside of primary state of residence
- Bonus program eligibility
- Remote/work-from-home position
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