Case Manager, RN – Licensed in all 50 states

🕒 il y a 1 mois

🇺🇸 États-Unis – Télétravail

💵 $72 000 - $81 000 / an

⏰ Temps Plein

🟠 Senior

🔴 Expert

👔 Manager

👻 Score fantôme 21%

Ce que ça veut dire : la probabilité que cette offre reste ouverte sans recrutement actif.Comment le lire : 60 % ou plus, on pense que c'est une offre fantôme. Un score plus bas est moins inquiétant.Comment on la calcule : ancienneté, republications, postes ouverts vs taille de l'équipe, rapidité de clôture, et si le salaire est indiqué.À noter : une estimation à partir de données publiques, pas un jugement sur l'entreprise. De vraies offres peuvent avoir un score élevé, alors prenez-le comme un indice, pas comme un fait.

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MedWatch, LLC

Site WebLinkedInTous les Emplois

201 - 500 employés

Fondée en 1988

💼 Conseil

📦 Logistique

🛡️ Assurance

Consulting • Logistics • Insurance

MedWatch, LLC est une entreprise de services de santé qui offre des services de gestion de l'utilisation, de gestion de cas, de gestion des maladies, de défense des membres et de coordination de soins concierge aux payeurs, TPA et employeurs auto-assurés. Depuis plus de 35 ans, elle propose une gestion de soins cliniquement orientée, des solutions de précertification et de gestion des réclamations, des contrats directs et des services annexes soutenus par des accréditations URAC et une technologie interne propriétaire pour améliorer les résultats cliniques et réduire les coûts du plan et des membres.

Description

• Manage an individual caseload using the case management process • Authorize services and review treatment plans for medical necessity and standards of care • Maintain ongoing communication with healthcare team members, providers, payers, patients, and caregivers • Review medical data and establish, update, and maintain case management plans • Assess patient problems, determine goals and actions, and document case notes • Evaluate benefit constraints and coordinate with payer offices • Verify medical necessity of ordered care and equipment with providers and vendors • Arrange quality patient care according to patient needs, physician orders, and available benefits • Manage case management files with the Case Management Assistant and maintain responsibility for the case management file • Identify alternative treatments and provide cost-benefit analyses for extra-contractual services when appropriate • Use community resources and funding sources to support patient care and conserve benefit-plan dollars • Document all case actions in the computer system and maintain billing • Prepare timely reports to payers detailing case actions, results, and continuing plans • Maintain contact with providers and patients across the continuum of care • Keep chronic-condition cases open for periodic clinical-status and medical-needs contacts • Negotiate with providers and make network referrals • Address non-medical issues affecting patient safety or welfare and direct patients or families to appropriate resources or authorities • Consult regularly with the CM supervisor regarding complaints and issues outside the case manager’s expertise • Participate in the Quality Management Program and identify service-improvement opportunities • Adhere to company policies and procedures

🎯 Exigences

• Current, active, and unrestricted Registered Nurse license in the state of current practice and residence within the United States or its territories • Registered Nurse licensed in all 50 states, including non-compact states • R.N. credential • Bachelor’s degree in a health-related field preferred • 7 years of varied clinical experience preferred • Must possess a URAC-recognized certification in Case Management within 3 years of hire • Practice within the scope of nursing licensure • Ability to work in a home office with prolonged computer sitting • Hand-eye coordination and manual dexterity sufficient to operate standard office, computer, and phone equipment • Ability to work in the United States for any employer without sponsorship

🏖️ Avantages

• Paid time off • Medical insurance • Dental insurance • Vision insurance • Short-term disability • Long-term disability • Life insurance • AD&D coverage • 401(k) with match • Critical illness coverage • Legal plan • Identity theft coverage • Pet insurance • Discount programs • MedWatch reimburses for renewals of RN licenses outside of primary state of residence • Bonus program eligibility • Remote/work-from-home position