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Medical Case Manager

2 months ago

Indianapolis, Indiana, United States International Medical Group Full time
Job Summary

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

Key Responsibilities
  • Evaluate medical necessity and appropriateness of healthcare services, procedures, and facilities for utilization review and/or evacuation/repatriation
  • 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
  • Perform certifications, concurrent reviews, retrospective reviews, and medical evacuations/repatriations, including inpatient and outpatient management of assistance cases
  • Participate in the on-call rotation schedule and provide telephone and email-based pre-travel advice
  • Direct and/or re-direct members to in-network providers and negotiate discounts with out-of-network providers
  • Direct healthcare team members to utilize alternative care settings when appropriate
  • Identify potential large case management cases by diagnosis, dollar amount, and/or high utilization of medical services and refer those identified for large case management
Requirements
  • Current and active nursing license - Registered Nurse
  • Minimum two years acute hospital-based experience providing direct patient care
  • Good computer skills, including familiarity with the Internet, Word, and Excel
  • B.S.N. preferred
  • Minimum two years utilization review with a managed care or insurance company
  • Proficient verbal and written communication skills in a foreign language preferred