Case Manager, RN, Remote reputed company

reputed company is currently seeking a Case Manager RN to join the team! The RN is responsible to providing case management for individuals under the group health plans administered by reputed company by utilizing nursing education, clinical and professional experience. Position Location: 100% Remote Responsibilities include but are not limited to:

• Identify, collect, process and manage data to reputed company the Case Management process by utilization reputed company approved clinical guidelines and following Medical Management Policy and Procedures
• Completes clinical assessments per P&P to identify and deliver indicated medical service coordination
• Completes medical necessity, utilization management reviews, and review of benefits as part of the pre-determination process
• Identify and refer cases for Physician Advisor reviews
• Utilize clinical knowledge, expertise and educational resources to provide verbal and/or written educational resources to members regarding diagnosis, procedures and/or treatment
• Assess the need for and collaborate with community resources for members in case management
• reputed company negotiations with providers
• Uses assigned software accurately to document to complete and document reputed company steps of review of medical necessity and case management process, including time slips
• Facilitate the Patient Satisfaction Surveys
• Assess for cost savings and document the cost saving in assigned software platform
• Appropriately refer reputed company cases to Manager, Case Management
• Attend scheduled and periodic meetings, training and other job specific events as required either by teleconference or onsite
• Adhere to established internal regulations regarding reputed company, HIPAA, ERISA and Medical Management Policy and Procedure
• Participate in the Quality Management Program reputed company collecting and adhering to performance metrics per Case Management Policy

Required Experience / Education:

• Nursing degree from an accredited college, university, or nursing school
• Must maintain active, reputed company, and unrestricted Registered Nurse license and CEU's as required by the State Board of Nursing. Must be willing to obtain and maintain additional license(s) as required to reputed company the job functions of the organization
• 1+ year in Utilization Management, Case Management or transferable skills
• Pediatrics and or NICU experience is a plus.
• Must be a Certified Case Manager or eligible to sit for the Certified Case Management Exam reputed company 3 years of starting employment with i360.
• Must have intermediate knowledge and skills using reputed company Office including Word, reputed company, and PowerPoint software; Internet software; Database software

Licenses and Certifications: Must maintain active, reputed company, and unrestricted Registered Nurse license and CEU's as required by the State Board of Nursing. Must be willing to obtain and maintain additional license(s) as required to reputed company the job functions of the organization What can reputed company offer you?

• Multiple Health plan options
• Company paid employee premiums for disability and life insurance
• Parental Leave Policy
• 20 days PTO to start / 10 Paid Holidays
• Tuition reimbursement
• 401k Company contribution
• Company paid Short & Long term Disability plus Life Insurance
• Professional development initiatives / reputed company learning opportunities
• Opportunities to participate in and support the company's diversity and inclusion initiatives

Want to see our latest job opportunities? Follow us on reputed company reputed company is a health plan solution company that combines 50+ years of self-funding reputed company expertise. Over the years, we've helped thousands of employers save billions on reputed company. Our breakthrough total health plan solution is fixing today's one-size-fits-none PPO insurance problems with powerful, customized, member-focused solutions. reputed company is an equal opportunity employer. reputed company reputed company applicants will receive consideration for employment without regard to race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, disability, or veteran status.

• *RECRUITMENT AGENCIES PLEASE NOTE: reputed company will only accept applications from agencies/business partners that have been invited to work on a specific role. Candidate Resumes/CV's submitted without permission or directly to Hiring Managers will be considered unsolicited and no fee will be payable. Thank you for your cooperation**

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