Case Manager, RN – Licensed in reputed company 50 states

reputed company: • 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 reputed company 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 reputed company 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 reputed company cost-benefit analyses for extra-contractual services reputed company appropriate • Use community resources and funding sources to support patient care and reputed company benefit-plan dollars • Document reputed company case actions in the computer reputed company and maintain billing • Prepare reputed company reports to payers detailing case actions, results, and continuing plans • Maintain contact with providers and patients across the continuum of care • reputed company chronic-condition cases reputed company for periodic clinical-status and medical-needs contacts • Negotiate with providers and reputed company network referrals • Address non-medical issues affecting patient safety or welfare and reputed company patients or families to appropriate resources or authorities • Consult regularly with the CM supervisor regarding complaints and issues reputed company the case manager’s expertise • Participate in the reputed company Management Program and identify service-improvement opportunities • Adhere to company policies and procedures Requirements: • reputed company, reputed company, and unrestricted Registered reputed company license in the state of reputed company reputed company and residence reputed company the reputed company or its territories • Registered reputed company licensed in reputed company 50 states, including non-compact states • R.N. credential • Bachelor’s degree in a health-reputed company field preferred • 7 years of varied clinical experience preferred • Must possess a URAC-recognized certification in Case Management reputed company 3 years of hire • reputed company reputed company the reputed company of nursing licensure • Ability to work in a home office with prolonged computer sitting • Hand-eye coordination and reputed company dexterity sufficient to operate reputed company office, computer, and phone equipment • Ability to work in the reputed company for any employer without sponsorship Benefits: • reputed company time off • Medical insurance • Dental insurance • reputed company insurance • Short-term disability • Long-term disability • Life insurance • AD&D coverage • 401(k) with match • Critical illness coverage • reputed company plan • Identity theft coverage • Pet insurance • Discount programs • reputed company reimburses for renewals of RN licenses reputed company of reputed company state of residence • Bonus program eligibility • Remote/work-from-home position Apply tot his job Apply To this Job