[Hiring] Case Manager (Specialty) / RN @MedWatch

Role Description

The Case Manager manages an individual caseload using the Case Management process to meet the needs of 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

Qualifications

• R.N.
• Bachelor's degree in a health-related field preferred

Requirements

• Registered Nurse (current active and unrestricted, in state of current practice and residence, within the United States or its territories)
• 7 years of varied clinical experience preferred
• Good organizational skills and time management
• Excellent verbal and written communication skills
• Ability to handle difficult situations tactfully and diplomatically
• Effective problem solving and decision-making skills
• Strong computer skills with proficiency in MS Office Suite products (Word, Excel, Power Point)

Eligibility Criteria

• Independently manages a full case load while maintaining URAC standards
• Capable of managing complex MNRs with accuracy
• Consistently scores 90% or greater on monthly audits

Duties and 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.
• Incorporate contact with providers, payers, the patient, and the patient's primary caregiver.
• Assess problems and determine goals and actions designed to meet the needs of the patient and document this into 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/intervention the Case Manager will take to work towards achieving those goals.
• Make contact with the payer office to understand any benefit constraints that will impact the plan of action.
• Adhere to all company policies as stated in the employee handbook.
• Participate in the Quality Management Program by adhering to all company policies and procedures.
• Identify opportunities for improvement to ensure quality services are rendered to clients and customers.
• The incumbent may be responsible for duties or responsibilities that are not listed in this job description.
• Duties and responsibilities may change at any time with or without notice.

Salary

The salary range for this position is from $72,000 to $81,000 annually.

Work Environment / Physical Demands

This position is in a typical office/home office environment which requires:

• Prolonged sitting in front of a computer
• Hand-eye coordination and manual dexterity sufficient to operate standard office equipment including operation of standard computer and phone equipment

Equal Opportunity Employer

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