Case Manager, RN

🕒 January 15

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MedWatch, LLC

WebsiteLinkedInAll Job Openings

201 - 500 employees

Founded 1988

⚕️ Healthcare Insurance

🤝 B2B

Healthcare Insurance • B2B

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 • authorization of services • review of treatment plans for medical necessity • ongoing communication with all members of the health care team • practice within the scope of licensure • review all medical data to establish and maintain accountability for a case management plan • assess problems and determine goals and actions designed to meet the needs of the patient • contact the payer office to understand any benefit constraints • contact medical care providers and equipment vendors to verify medical necessity • make care arrangements for quality patient care • work in conjunction with the Case Management Assistant • maintain and document case actions for each patient • negotiate with providers to maximize medical benefits available to the patient • adhere to all company policies

🎯 Requirements

• Registered Nurse (current active and unrestricted, in state of current practice and residence, within the United States or its territories) • R.N., a bachelor’s degree in a health-related field preferred • 7 years of varied clinical experience preferred

🏖️ 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