[Hiring] Case Manager / RN @MedWatch

Role Description

The Case Manager manages an individual caseload using the case management process in order to meet the needs of the MedWatch, LLC customers and consumers. This includes, but is not limited to:

• Authorization of services
• Review of treatment plans for medical necessity
• Standards of care
• Ongoing communication with all members of the health care team

This is a remote/work-from-home position.

Qualifications

• Registered Nurse (current active and unrestricted, in state of current practice and residence, within the United States or its territories)
• Being licensed in ALL 50 States (including non-compact states)
• MedWatch reimburses for renewals of RN licenses outside of primary state of residence
• R.N., a bachelor’s degree in a health-related field preferred
• 7 years of varied clinical experience preferred

Requirements

• Practice within the scope of licensure
• Review all medical data to establish, update, and maintain accountability for a case management plan
• Assess problems and determine goals and actions designed to meet the needs of the patient
• Make contact with the payer office to understand any benefit constraints
• Contact medical care providers and equipment vendors to verify medical necessity
• Make care arrangements for quality patient care according to the needs of the patient
• Work in conjunction with the Case Management Assistant to manage case management files
• Be aware of alternative treatment possibilities
• Become familiar with community resources and funding sources
• Maintain case in computer system documenting case actions for each patient
• Maintain billing as appropriate in computer system
• Continue to maintain contact with providers and patients across the continuum of care
• Negotiate with providers to maximize medical benefits available to the patient
• Act upon awareness of non-medical issues involving the patient’s safety or welfare
• Consult with the CM supervisor on a regular basis
• Adhere to all company policies as stated in the employee handbook
• Possess a URAC-recognized certification in Case Management within 3 years of hire
• Participate in the Quality Management Program

Benefits

• 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 front of a computer
• Hand-eye coordination and manual dexterity sufficient to operate standard office equipment

We are an Equal Opportunity Employer, including disability/veterans.