Case Manager Assistant, LPN – Bilingual

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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

• Assist the RN Case Manager with case management functions under direct supervision • Authorize services and review treatment plans for medical necessity and standards of care • Communicate with providers, payers, patients, and primary caregivers • Review medical data and update case management plans • Contact payers to understand benefit constraints affecting the plan of action • 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 • Evaluate alternative treatment possibilities and prepare cost-benefit analyses when extra-contractual services may be appropriate • Identify community resources and funding sources to support patient care • Document case actions and complete all case information in the computer system • Prepare timely reports for payers for Case Manager review • Maintain billing in the computer system as appropriate • Maintain contact with providers and patients across the continuum of care • Monitor chronic-condition cases through periodic contacts • Negotiate with providers to maximize available medical benefits • Make network referrals as appropriate • Address patient safety or welfare concerns by directing patients or families to resources or notifying authorities in consultation with the Case Manager • Consult regularly with the Case Manager and inform the Director of Case Management about complaints or issues beyond the assistant's expertise • Adhere to company policies and participate in the Quality Management Program

🎯 Requirements

• Current, active, and unrestricted Licensed Practical Nurse license or Medical Assistant/Nursing Assistant certification in the current state of practice and residence within the United States or its territories • 3 years of experience in a specialty field required as an alternative to the preferred 5 years of varied clinical experience • Basic computer skills • Strong computer skills and proficiency in Microsoft Office Suite, including Word, Excel, and PowerPoint • 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 • Fluent English and Spanish, with strong reading and writing abilities in both languages • Ability to practice within the scope of licensure • Ability to work in the United States without employer sponsorship • Dedicated, quiet home workspace • Licensed Practical Nursing education is preferred

🏖️ Benefits

• Paid time off • Medical insurance • Dental insurance • Vision insurance • Short-term disability • Long-term disability • Life insurance • AD&D insurance • 401(k) with match • Critical illness coverage • Legal plan • Identity theft coverage • Pet insurance • Discount programs • Bilingual Spanish-speaking pay differential • Remote work arrangement