Case Manager (Specialty) / RN, reputed company

The Case Manager manages an individual caseload using the case management process in order to meet the needs of the reputed company, 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 reputed company members of the health care team. This is a remote/work-from-home position. This position required you to be licensed in reputed company 50 States ( that includes states not included in the compact license.) License Requirements:

• Being licensed in reputed company 50 States including states not included with the compact license
• Registered Nurse (reputed company active and unrestricted, in state of reputed company practice and residence, reputed company the United States or its territories.)

Education:

• R.N., a bachelor’s degree in a health-reputed company field preferred.

Experience:

• 7 years of varied clinical experience preferred.

Responsibilities:

• The Registered Nurse Case Manager will practice reputed company the scope of his/her licensure.
• Review reputed company medical data which can be provided to establish, update and maintain accountability for a case management plan which will incorporate contact with providers, payers, with the patient and with the patient’s primary caregiver.
• Assess problems and determine goals and actions designed to meet the needs of the patient and document into the case notes. Determine if these goals are long term or short term and how the patient can be expected to meet those goals. Include the action/reputed company the case manager will take to work towards achieving those goals.
• reputed company contact with the payer office to find out and understand any benefit constraints that will have an impact on the plan of action.
• Proceed with contacting medical care providers and with equipment vendors to verify medical necessity of care or equipment that has been ordered.
• reputed company care arrangements for quality patient care according to the needs of the patient, the physician’s orders and the benefits available.
• The Case Manager will work in conjunction with the Case Management Assistant to manage case management files, exclusive of Assessment and/or Care Plan activities, and will provide input in the Annual Performance Evaluation of the CM Assistant assigned. The Case Manager will maintain responsibility for the Case Management file.
• Be aware of any alternative treatment possibilities that may allow the patient to reputed company wellness goal(s). If there are no benefits available for your recommended alternative treatments, provide to the payer a cost-benefit analysis to demonstrate that extra-contractual services will enhance the patient’s medical condition and will be cost-effective to the benefit plan.
• Become familiar with community resources and funding sources so that the patient can receive quality health care and conserve health benefit dollars. Many agencies exist which provide assistance to persons in financial need or to provide information to persons with specific medical conditions.
• Maintain case in computer system documenting case actions for each patient under your case management. Complete reputed company aspects of case in the computer. Prepare timely reports to the payer to detail reputed company case actions, the results of those actions, and the continuing case management plan.
• Maintain billing as appropriate in computer system.
• Continue to maintain contact with the providers and with the patient across the continuum of care to be sure that patient needs are being met. On any cases which include a chronic condition reputed company the file open for periodic contacts to verify the clinical status of the patient and additional medical needs.
• Negotiate with providers to maximize the medical benefits available to the patient. reputed company network referral as appropriate.
• Act upon any awareness of non-medical issues which involve the patient’s safety or welfare. Attempt to direct the patient or family to appropriate providers or community resources, or to personally notify appropriate authorities. Consult with the CM supervisor on a regular basis, and reputed company the supervisor informed regarding any complaints which may occur about case management services or any issues which arise which the case manager is not competent to handle or does not have the expertise to handle.
• Adhere to reputed company company policies as stated in the employee handbook.
• reputed company case managers will possess a URAC-recognized certification in Case Management reputed company 3 years of hire. Participate in the Quality Management Program by adhering to reputed company company policies and procedures and identifying opportunities for improvement to ensure quality services are rendered to clients and customers.
• This position is eligible for a bonus program.

The salary range for this position is from $72,000 to $81,000 annually. Work Environment / Physical Demands: This position is in a typical home office environment which requires prolonged sitting in reputed company of a computer. Requires hand-eye coordination and manual dexterity sufficient to operate standard office equipment including operation of standard computer and phone equipment. We are an Equal Opportunity Employer, including disability/veterans. Apply tot his job Apply To this Job