Case Manager MNR RN

Visa Hunt; United States; Hybrid; USD 72,000 - 75,000; Full time

Job summary

MedWatch, LLC is seeking a Registered Nurse Case Manager to oversee an individual caseload using the Case Management process to address members' needs, authorize services, review treatment plans, and maintain communication with the health care team. The role emphasizes compliance with URAC standards and collaboration with payers and providers.

Ideal candidates hold an active RN license, prefer a Bachelor's in a health-related field, and bring strong organizational, communication, and

Qualifications

• Active Registered Nurse license in the United States or territories.
• Bachelor's degree in a health-related field preferred.
• 7 years of varied clinical experience preferred.

Responsibilities

• Review medical data to establish and maintain a Case Management plan with providers, payers, patient and caregiver.
• Assess problems and determine goals and actions to meet patient needs; document in case notes.
• Contact payer offices to understand benefit constraints affecting the plan of action.
• Adhere to company policies as stated in the employee handbook.
• Participate in Quality Management Program and identify opportunities for improvement.
• Duties may change at any time with or without notice.

Skills

Organizational skills

Verbal and written communication

Diplomacy in difficult situations

Problem solving

MS Office proficiency

Education

RN licensure

Bachelor's degree preferred

Tools

MS Word

MS Excel

MS PowerPoint

Job description

Scope

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, and ongoing communication with all members of the health care team.

Education

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

Licensure/Certification Requirements

• Registered Nurse (current active and unrestricted, in state of current practice and residence, within the United States or its territories.)

Experience

• 7yearsofvariedclinicalexperiencepreferred.

Requirements/Skills

• 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

• Independence: Independently manages a full case load while maintaining URAC standards and is capable of managing complex MNRs with accuracy and 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 which can be provided to establish, update and maintain accountability for a Case Management plan which will incorporate contact with providers, payers, 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 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 find out and understand any benefit constraints that will have an impact on 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 and identifying 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.

The salary range for this position is from $72,000 to $75,000 annually.

Work Environment / Physical Demands

This position is in a typical office / home office environment which requires prolonged sitting in front of a computer. 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

Originally posted on Himalayas