Nurse Case Manager

4 days ago

Indianapolis, Indiana, United States International Medical Group Full time
Job Title: Nurse Case Manager I

We are seeking a skilled and compassionate Nurse Case Manager to join our team at International Medical Group. As a key member of our healthcare team, you will play a vital role in evaluating medical necessity, appropriateness, and efficiency of healthcare services, procedures, and facilities for utilization review and/or evacuation/repatriation.

Job Summary

The successful candidate will work as a liaison between the insured, the insurance carrier, and the insured's healthcare team to meet the requirements of the insured's policy in the United States and abroad. You will be responsible for performing certifications, concurrent reviews, retrospective reviews, and medical evacuations/repatriations, including inpatient and outpatient management of assistance cases.

Responsibilities
  • Evaluate medical necessity and appropriateness of healthcare services, procedures, and facilities
  • Work as a liaison between the insured, insurance carrier, and healthcare team
  • Perform certifications, concurrent reviews, retrospective reviews, and medical evacuations/repatriations
  • Manage inpatient and outpatient assistance cases
  • Identify potential large case management cases and refer them for large case management
  • Document information and status in case management systems
  • Prepare precertification and/or case management reports as needed
Requirements
  • Current and active RN license in good standing in Indiana
  • Minimum two years acute hospital-based experience providing direct patient care
  • Good computer skills, including familiarity with the Internet, Word, and Excel
Preferred Skills
  • B.S.N. preferred
  • Minimum two years utilization review experience with a managed care or insurance company
  • Proficient verbal and written communication skills in a foreign language preferred
  • Excellent computer skills, including database knowledge
Professional Competencies
  • Communication - must be able to express ideas clearly, concisely, and logically
  • Initiative - proactive in resolving problems, reporting discrepancies, suggesting new ideas, and seeking process improvements
  • Judgment - use of good clinical judgment in resolving questions of medical necessity
  • Flexibility - must be willing to adjust as the industry or job requirements change
  • Teamwork - must work well in a team and help foster a cooperative environment
Work Conditions
  • Office environment setting
  • Able to work comfortably in a desk environment
  • 90% of the time spent sitting, doing keyboard entry, and utilizing a mouse

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