Case Manager, RN – 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

• 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 providers, payers, patients, caregivers, social workers, insurance teams, and other healthcare team members • Develop, update, and maintain accountability for Case Management plans • Assess patient problems, determine goals and interventions, and document case notes • Verify benefit constraints 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 and maintain responsibility for the Case Management file • Identify alternative treatments and prepare cost-benefit analyses when extra-contractual services may be appropriate • Connect patients with community resources and funding sources • Document all case actions and complete case records in the computer system • Prepare timely reports to payers detailing case actions, results, and continuing plans • Maintain billing in the computer system as appropriate • Maintain contact across the continuum of care and periodically monitor chronic-condition cases • Negotiate with providers to maximize medical benefits and make network referrals • Address non-medical issues involving patient safety or welfare • Consult regularly with the Director of Case Management and inform the supervisor of complaints or issues requiring escalation • Participate in the Quality Management Program and identify opportunities for service improvement • Provide input in the annual performance evaluation of the assigned Case Management Assistant

🎯 Requirements

• Registered Nurse (R.N.) • Current, active, and unrestricted RN license in the state of current practice and residence within the United States or its territories • Bachelor's degree in a health-related field preferred • 7 years of varied clinical experience preferred • Good organizational and time-management skills • Excellent verbal and written communication skills • Ability to handle difficult situations tactfully and diplomatically • Effective problem-solving and decision-making skills • Strong computer skills • Proficiency in Microsoft Office Suite, including Word, Excel, and PowerPoint • Fluent English and Spanish, with strong reading and writing abilities in both languages • Ability to manage moderate-complexity cases independently and contribute to team goals • Must obtain a URAC-recognized certification in Case Management within 3 years of hire • Ability to work in the United States without employer sponsorship

🏖️ 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 • Bonus program eligibility • Pay differential for bilingual Spanish-speaking employees