Case Manager, RN

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November 6

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GuideWell Source

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Healthcare Insurance • Government • Enterprise

GuideWell Source is a company within the GuideWell Family that focuses on accelerating innovative health solutions to market, transforming and reshaping the health industry. It specializes in healthcare delivery, providing new models and superior outcomes for patients. The company emphasizes consumerism in healthcare, engaging clients in meaningful ways. GuideWell Source offers healthcare insurance, protecting employers and consumers with coverage plans and services. The company also provides administrative and claims processing services for state and federal Medicare and Medicaid programs, establishing itself as a trusted business partner in the healthcare sector with a focus on operational excellence.

1001 - 5000 employees

⚕️ Healthcare Insurance

🏛️ Government

🏢 Enterprise

📋 Description

• Case Management process includes assessing the member’s health status and care coordination needs. Can include inpatient review and discharge planning, as well as possible outpatient management. • Contact with patient, family, physicians, additional health care providers, and community resources. Contact with provider business offices and with the employer/client may also be required. • Identification of alternative treatment plans, which would have to be approved by all parties. These alternative care plans will be based on quality care within cost containment guidelines, allowing available claims dollars to be used in the most judicious manner possible. • Assessment of the clinical status and resultant sequela to coordinate the most appropriate service to meet the individual’s health care needs. The Case Manager will then monitor the health status and the impact of the treatment plan for each client. The Case Manager will be responsible for altering the care plan as deemed appropriate by the dynamic, ever-changing client needs. • Identification of services, resources, providers, and facilities that could best serve members in a timely and cost-effective manner, to promote optimum value for the client and reimbursement source. • Development and implementation of Case Management goals, both short and long term, with documented care plans. • Utilize technology/resources to evaluate the cost-effectiveness of the elected treatment plan, pre-implementation and post-implementation. This outcome measurement will be used in determining the effective results and in establishing future patient-centered care plans. • Accurate and timely reporting as deemed appropriate by each client member. • Medical record review to determine medical necessity of requested services. • Interpreting individual health plans and authorizing/coordinating care in accordance with plan provisions.

🎯 Requirements

• 5+ years related work experience with a professional background in clinical nursing and patient assessment. • Related Bachelor’s degree or additional related equivalent work experience • Graduate of an accredited school of nursing • RN - Registered Nurse Licensure • Compact State Licensure in good standing. • Knowledgeable in medical terminology, reasonable and necessary treatment plans, delivery quality health care services and cost containment practices. • Ability to collaborate with cross-operational areas within the organization.

🏖️ Benefits

• Medical, dental, vision, life and global travel health insurance • Income protection benefits: life insurance, Short- and long-term disability programs • Leave programs to support personal circumstances • Retirement Savings Plan includes employer contribution and employer match • Paid time off, volunteer time off, and 11 holidays • Additional voluntary benefits available and a comprehensive wellness program