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Case Manager MNR RN

MedWatch, LLC

Role overview

Qualifications

  • Registered Nurse (current active and unrestricted)
  • Bachelor's degree in a health-related field preferred
  • 7 years of varied clinical experience preferred
  • Good organizational skills and time management

Responsibilities

  • Independently manage a full caseload while maintaining URAC standards
  • Review all medical data and establish/update a Case Management plan
  • Assess problems and determine goals/actions for patient needs
  • Make contact with payer office to understand benefit constraints

Key facts

Hard skills

Medical Necessity Nursing

Other skills

  • Problem Solving
  • Decision Making
  • Microsoft Office
  • Organizational Skills
  • Time Management
  • Communication
  • Tactfulness
  • Diplomacy

About the company

MedWatch, LLC logo

MedWatch, LLC

Hospitals & Health Care

Since 1988, MedWatch has been a leader in providing concierge member advocacy and medical cost containment solutions for TPAs, employer groups, school systems, municipalities, hospital systems, Taft-Hartley plans, and fully insured payers as well as for the reinsurance industry and stop loss carriers. MedWatch has maintained continuous URAC Accreditation for Health Utilization Management since 1997, Case Management since 2000, and Disease Management since 2007. These core services, along with all of our proven solutions, focus on appropriateness and quality of care, helping to achieve the best clinical and financial outcomes for plans and plan members. MedWatch’s programs fit together seamlessly to support members along the entire continuum of their health journey. Pathways Concierge, our white-glove service, provides members with a single point of contact to address questions about their health plan. It’s the starting point and finish line for successful member engagement and effective utilization of benefits. In addition to Pathways Concierge and our URAC Accredited core services, MedWatch offers over 30 advocacy and cost containment solutions including dialysis claims repricing, diabetic monitoring and intervention, high-cost infusion/oncology treatment savings, in and out of network savings for high-cost claims, and more. MedWatch is the Right Choice for providing the Right Care at the Right Time in the Right Place for the Right Cost. Learn how MedWatch’s proven solutions, innovative approach and clinical expertise make us the Right Partner for you: Visit urmedwatch.com.

Company details

Company typeSME
IndustryHospitals & Health Care
Company size201 - 500

Links

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Job description

Scope:
The Case Manager manages an individual caseload using the Case Management process to meet the needs of MedWatch, LLC customers and consumers. This includes, but is not limited to, authorization of services, review of treatment plans for medical necessity, standards of care, and ongoing communication with all members of the health care team.

Education:
  • R.N.
  • Bachelor's degree in a health-related field preferred.

Licensure/Certification Requirements: 
  • Registered Nurse (current active and unrestricted, in state of current practice and residence, within the United States or its territories.)
Experience:
  • 7 years of varied clinical experience preferred.

Requirements/Skills:
  • 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.
  • Strong computer skills with proficiency in MS Office Suite products (Word, Excel, Power Point)

Eligibility Criteria:
  • Independence: Independently manages a full case load while maintaining URAC standards and is capable of managing complex MNRs with accuracy and consistently scores 90% or greater on monthly audits.

Duties and Responsibilities:
  • The Registered Nurse Case Manager will practice within the scope of his/her licensure.
  • Review all medical data which can be provided to establish, update and maintain accountability for a Case Management plan which will incorporate contact with providers, payers, the patient and with the patient's primary caregiver.
  • Assess problems and determine goals and actions designed to meet the needs of the patient and document this into case notes. Determine if these goals are long term or short term and how the patient can be expected to meet those goals. Include the action/intervention the Case Manager will take to work towards achieving those goals.
  • Make contact with the payer office to find out and understand any benefit constraints that will have an impact on the plan of action.
  • Adhere to all company policies as stated in the employee handbook.
  • Participate in the Quality Management Program by adhering to all company policies and procedures and identifying opportunities for improvement to ensure quality services are rendered to clients and customers.
  • The incumbent may be responsible for duties or responsibilities that are not listed in this job description. Duties and responsibilities may change at any time with or without notice.
The salary range for this position is from $72,000 to $75,000 annually.

Work Environment / Physical Demands: This position is in a typical office / home office environment which requires prolonged sitting in front of a computer.  Requires hand-eye coordination and manual dexterity sufficient to operate standard office equipment including operation of standard computer and phone equipment. 

We are an Equal Opportunity Employer including disability/veterans

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MR

Marcus Rivera

Chief Revenue Officer

m.rivera@company.com
linkedin.com/in/marcusrivera
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