Case Manager MNR RN
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AI Summary
The Case Manager handles an individual caseload, managing authorizations and reviewing treatment plans for medical necessity. They coordinate with providers, payers, and patients to establish and maintain comprehensive case management plans.
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:
Licensure/Certification Requirements:
Requirements/Skills:
Eligibility Criteria:
Duties and Responsibilities:
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
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.)
- 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.
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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