Case Manager MNR RN

About the Role

The Case Manager manages an individual caseload using the Case Management process to meet the needs of MedWatch, LLC customers and consumers. This includes authorization of services, review of treatment plans for medical necessity and standards of care, and ongoing communication with all members of the healthcare team.

Responsibilities

• Practice within the scope of licensure as a Registered Nurse Case Manager.
• Review all medical data to establish, update, and maintain accountability for a Case Management plan, incorporating contact with providers, payers, the patient, and the patient’s primary caregiver.
• Assess problems, determine goals, and document actions designed to meet the patient’s needs in case notes.
• Determine if goals are long-term or short-term and outline the patient’s expected progress, including interventions the Case Manager will take.
• Contact the payer office to understand benefit constraints impacting the plan of action.
• Adhere to all company policies as stated in the employee handbook.
• Participate in the Quality Management Program by following company policies and identifying opportunities for improvement to ensure quality services.
• Perform additional duties or responsibilities as assigned, which may change with or without notice.

Requirements

• Registered Nurse (RN) with a current, active, and unrestricted license in the state of current practice and residence (United States or its territories).
• Bachelor’s degree in a health-related field preferred.
• Seven years of varied clinical experience preferred.
• Independently manage a full caseload while maintaining URAC standards, capable of handling complex medical necessity reviews (MNRs) with accuracy, and consistently score 90% or greater on monthly audits.

Skills

• Good organizational and time management skills.
• 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 (Word, Excel, PowerPoint).

Pay

$72,000 to $75,000 annually.

Work Environment

This position is in a typical office or home office environment, requiring prolonged sitting in front of a computer. Requires hand-eye coordination and manual dexterity sufficient to operate standard office equipment, including computers and phones.