Case Manager, MNR, RN

🕒 July 22

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MedWatch, LLC

WebsiteLinkedInAll Job Openings

201 - 500 employees

Founded 1988

💼 Consulting

📦 Logistics

🛡️ Insurance

Consulting • Logistics • Insurance

MedWatch, LLC is a healthcare services company that provides utilization management, case management, disease management, member advocacy and concierge care coordination to payers, TPAs, and self‑insured employers. For over 35 years it has delivered clinically driven care management, precertification and claims solutions, direct contracting and ancillary services backed by URAC accreditations and proprietary in‑house technology to improve clinical outcomes and reduce plan and member costs.

📋 Description

• Manage an individual caseload using the Case Management process to meet the needs of MedWatch, LLC customers and consumers • Authorization of services • Review of treatment plans for medical necessity • Ongoing communication with all members of the health care team • 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 for patient needs and document in case notes • Determine if goals are long term or short term and how the patient can meet those goals • Make contact with payer office to understand benefit constraints impacting the plan of action • Adhere to all company policies and participate in the Quality Management Program

🎯 Requirements

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

🏖️ Benefits

• paid time off • medical • dental • vision • short and long-term disability • life insurance • AD&D • 401k with match • critical illness coverage • legal plan • identity theft coverage • pet insurance • discount programs