[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)
• R.N., a bachelor’s degree in a health-related field preferred
• 7 years of varied clinical experience preferred

Responsibilities

• The Registered Nurse Case Manager will practice within the scope of his/her 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.
• Document goals into the case notes, determining if they are long term or short term.
• Make contact with the payer office to understand any benefit constraints impacting the plan of action.
• Contact medical care providers and equipment vendors to verify medical necessity of care or equipment.
• Make care arrangements for quality patient care according to the needs of the patient, physician’s orders, and available benefits.
• Work in conjunction with the Case Management Assistant to manage case management files.
• Maintain responsibility for the Case Management file.
• Be aware of alternative treatment possibilities for patient wellness goals.
• Provide cost-benefit analysis to the payer for extra-contractual services when necessary.
• Familiarize with community resources and funding sources for patient assistance.
• Maintain case documentation in the computer system, preparing timely reports to the payer.
• Maintain billing as appropriate in the computer system.
• Continue 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 patient safety or welfare.
• Consult with the CM supervisor regularly and keep informed about any complaints or issues.
• 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 by identifying opportunities for improvement.

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.