Nurse Case Manager I

Summary

Join our team at IMG, a top International Medical Insurance company, to help individuals and companies with global peace of mind. We're looking for a Case Manager to evaluate medical necessity and work with insureds, insurance carriers, and healthcare teams.

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

Responsibilities

• Perform Certifications, Concurrent Reviews, Retrospective Reviews, and Medical Evacuations/Repatriations including inpatient and outpatient management of assistance cases
• Knowledge of the Non-certification process and Appeals process including logs and time frames
• Participate in the on call rotation schedule
• The provision of telephone and email based pre travel advice
• Direct and/or re-direct members to in-network providers
• 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
• Document information and status in case management systems and document
• Prepare precertification and/or case management reports as needed
• Use good judgment when evaluating medical cases and confer with Medical Director when appropriate
• Communicate with other members of team as needed, and ensure that information is shared appropriately
• Maintain confidentiality and privacy of all protected health information
• Continue education through relevant reading materials, online courses and/or seminars
• Support and participate in Quality Management activities
• Utilize clinical support tools as indicated
• Maintain a working knowledge of the any applicable state or federal regulations as appropriate for job duties
• Report/document complaints when/if received

Benefits

• Comprehensive benefits package including Medical/RX/Dental/Vision insurance
• 401k Plan with company match
• Paid Time Off and Company Paid Holidays
• Free employee parking
• On site fitness center
• Casual dress environment
• Tuition reimbursement plan