Nurse Case Manager

Nurse Case Manager (Medical/Surgical)

Under the direction of the Case Management Supervisor, the Nurse Case Manager is responsible for providing telephonic case management services to MedCost customers. This position will work with the health care provider staff, via telephone, fax, and e-mail, in the coordination of care for members ranging from low acuity to catastrophic as they move through the care continuum. The Nurse Case Manager shall practice solely within the scope of a licensed registered nurse and individual competency and education for this position. The role requires experience providing direct patient care.

Position Responsibilities:

• Confirm eligibility and policy provisions.
• Obtain consent for case management services and communicates case management objectives to the patient and their primary caregiver/support system and determine patient and family desires.
• Gather clinical information to assess and initiate discharge planning from hospital admittance to discharge.
• Collaborate and communicate with the member's health care team to coordinate the care needs for the member.
• Review available resources of all providers to determine the means of providing the highest quality care in the most effective setting. Obtain an estimate of the patient's current costs from the provider or other sources and compare to those of the alternative means of providing the necessary care.
• Provide ongoing education to members regarding their health care needs, available benefits and services.
• Identify barriers to optimal care and outcomes or clinical concerns and communicate with member and providers to formulate action plan to address
• Work to facilitate member compliance with their care/treatment plan and to ensure continuity of care.
• Maintain detailed records of all care coordination activities and interventions in the member's health plan clinical record.
• Notify appropriate persons in writing or by telephone of any potentially high dollar claim and the projected continued costs.
• Monitor alternative services for effectiveness, continued medical necessity and coverage.
• Advise all concerned parties when coverage may no longer be available due to cessation of medical necessity or benefit exhaustion.
• Facilitate patient referrals to community-based funding resources.
• Evaluate the effectiveness of the case management process.

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.

Position Qualifications:

Required

• College degree in nursing, either ADN, BSN, or MSN
• Registered Nurse with a current, unrestricted North Carolina nursing license
• A minimum of 3 years direct care experience in varied health care settings

Preferred

• Prior case management, utilization review or disease management experience

Skills, Knowledge, and Abilities

• Excellent oral and written communication skills
• Exceptional customer service, and interpersonal skills
• Effective problem-solving and influencing skills
• Self- motivated with strong organizational and multi-tasking skills
• Proficient keyboarding skills
• Knowledge of computer programs such as Excel and Microsoft Word and Outlook
• Proficiency in navigating the Internet and multi-tasking with multiple electronic documentation systems simultaneously.
• Ability to work independently, handle multiple assignments and prioritize workload

At MedCost, we offer a comprehensive compensation package that includes:

Pay range for Nurse Case Manager (Medical/Surgical): $34.00-$38.00 per hour

Benefits for Nurse Case Manager (Medical/Surgical):

• Subsidized medical, prescription medication, and dental insurance;
• Company-paid life, AD&D, and disability insurance;
• 401K retirement program with matching company contributions;
• Health savings accounts with company contributions;
• Voluntary medical and dependent care flexible spending accounts;
• Voluntary vision, supplemental life, critical illness, accident, hospital indemnity, long-term care, and pet insurance;
• Paid time off and paid holidays;
• Annual wellness incentive program;
• Certification and training program; and
• Profit sharing plan.

MedCost provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.

MedCost participates in the Electronic Verification system (E-Verify) to electronically verify the work authorization of newly-hired employees. E-Verify is an internet-based program that compares information from an employee's Form I-9 to data contained in the federal records of the Social Security Administration and the Department of Homeland Security to confirm employment eligibility. MedCost does not use E-Verify to pre-screen job applicants.