Case Manager, RN

This is a fully remote position, open to applicants in United States.

📋 Description

• Oversee a personal caseload utilizing the case management process to fulfill the needs of MedWatch customers and consumers.

• Approve services and evaluate treatment plans for medical necessity and adherence to care standards.

• Maintain continuous communication with patients, caregivers, providers, payers, and the healthcare team.

• Analyze medical data and establish, update, and sustain case management plans.

• Evaluate patient issues and document goals, actions, interventions, and case notes.

• Confirm benefit limitations with payer offices.

• Reach out to medical care providers and equipment suppliers to validate medical necessity.

• Organize quality patient care based on patient requirements, physician directives, and available benefits.

• Manage case management files and uphold accountability for the case management documentation.

• Identify alternative treatments and provide cost-benefit analyses for out-of-network services when appropriate.

• Utilize community resources and funding sources to enhance patient care while conserving benefit funds.

• Record case actions and billing within the computer system.

• Generate timely reports for payers detailing case actions, outcomes, and ongoing plans.

• Maintain contact throughout the continuum of care and monitor cases involving chronic conditions.

• Negotiate with providers to optimize medical benefits and facilitate network referrals.

• Address issues related to patient safety or welfare and direct patients or families to the relevant resources or authorities.

• Regularly consult with the Case Management supervisor and report any complaints or issues outside the case manager’s scope of expertise.

• Comply with company policies and engage in the Quality Management Program.

⛳️ Requirements

• Active, unrestricted Registered Nurse license in the state of practice and residence within the United States or its territories.

• R.N. qualification.

• Bachelor’s degree in a health-related discipline preferred.

• A minimum of 7 years of diverse clinical experience preferred.

• Must operate within the parameters of RN licensure.

• Must obtain a URAC-recognized certification in Case Management within three years of employment.

• Eligibility to work in the United States for any employer without the need for sponsorship.

• A dedicated, quiet workspace at home.

• Proficient in using standard computer and telephone equipment.

• Capability for prolonged sitting and sufficient hand-eye coordination and manual dexterity for a home-office computer setting.

🏝️ Benefits

• Paid time off.

• Medical insurance.

• Dental insurance.

• Vision insurance.

• Short-term disability.

• Long-term disability.

• Life insurance.

• AD&D insurance.

• 401(k) with matching contributions.

• Critical illness coverage.

• Legal plan.

• Identity theft coverage.

• Pet insurance.

• Discount programs.

• Eligibility for bonus programs.