Case Manager RN - Remote

Overview

The Case Manager manages an individual caseload using the case management process to meet the needs of the MedWatch, LLC customers and consumers. This includes authorization of services, review of treatment plans, and ongoing communication with the health care team. This is a remote/work-from-home position.

In Short

• Manage individual caseload and ensure service authorization.
• Review treatment plans for medical necessity and standards of care.
• Communicate with healthcare providers and payers.
• Assess patient needs and document case management plans.
• Coordinate care arrangements based on physician orders.
• Maintain case files and document actions in the system.
• Familiarize with community resources for patient assistance.
• Negotiate with providers to maximize medical benefits.
• Participate in quality management programs.
• Eligible for a bonus program.

Requirements

• Current active and unrestricted Registered Nurse license.
• Bachelor's degree in a health-related field preferred.
• 7 years of varied clinical experience preferred.
• URAC-recognized certification in Case Management within 3 years of hire.
• Proficient in documentation and case management software.
• Strong communication skills with healthcare teams.
• Ability to assess patient needs and develop care plans.
• Knowledge of medical necessity and benefit constraints.
• Familiarity with community resources and funding sources.
• Adherence to company policies and procedures.

Benefits

• Remote work opportunity.
• Competitive salary range.
• Bonus program eligibility.
• Equal Opportunity Employer, including disability/veterans.
• Supportive work environment.
• Opportunities for professional development.
• Health benefits and insurance options.