An insurance company has an open position for a Virtual Medical Case Manager. Individual must be able to fulfill the following responsibilities: Provide telephonic case management on assigned workers’ compensation claims.
Performing continued stay medical necessity reviews. Communicating patient status, concurrent denials and medical necessity concerns. Qualifications Include: B. S. in Business Administration, Nursing or Healthcare or equivalent work experience. Registered Nurse (RN) with multistate license.
Using a holistic approach, consulting with clinical colleagues, supervisors, medical directors and/or other programs. Identifying and escalating quality of care issues through established channels. Applicants must meet the following qualifications:
Presenting a concise medical summary within each appeal based on support from the medical record. Composing clinical appeal letters to send to payers. Updating the patient account record to identify actions taken on the account. Must meet the following requirements for consideration:
A medical advocacy company needs applicants for an opening for a Telecommute Workers Compensation Field Nurse Case Manager. Individual must be able to fulfill the following responsibilities: Facilitating and coordinating all aspects of Medical and Non-Medical care.
Assess, plan, implement, coordinate, monitor and evaluate medical services and Return-To-Work options. Work telephonically and focus on disability and medical management activities that result in a timely and sustained RTW. Participate in roundtables, coordinate services and ongoing treatment.
Review medical charts and enter data into the computer system. Ensure that plans of care are person centered. Ensure that the services that the member receives are appropriate to meet their medical needs. Qualifications Include: Complete face to face comprehensive assessment of patients.
Must be able to: Ensure medically appropriate, high-quality, cost-effective care through assessing the medical necessity of inpatient admissions and extensions. Partner with physician clinical reviewers and/or medical directors to interpret appropriateness of care.
A provider of medical services has an open position for a Telecommute Case Manager Registered Nurse. Core Responsibilities Include: Conducting evaluations of member's needs and benefit plan eligibility. Reviewing prior claims to address potential impact on current case management.
Completion of an accredited Licensed Practical Nurse (LPN) Program. 1-3 years experience in case management, home health or medical or behavioral health settings. If licensed, license must be active, unrestricted and in good standing.