Nurse Case Manager I

JOB DETAILS

• RN License -- Must have an active RN license in good standing in Indiana.
• Location:  Hybrid or Remote working options. 
• Corporate office is in Indianapolis, IN.
• Relocation Expenses Reimbursed:  No
• Qualified candidates must be legally authorized to be employed in the United States. IMG will not be providing sponsorship for employment visa status (e.g., H-1B or TN status) for this position.

JOB SUMMARY

PERKS

• 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

DUTIES AND 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 oncall 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.
• Any other job duties or tasks as assigned.

QUALIFICATIONS

• 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.

PREFERRED SKILLS

• B.S.N. Preferred
• Minimum two years utilization review with a managed care or insurance company
• Proficient verbal and written communication skills in a foreign language preferred
• Excellent computer skills, including database knowledge.
• Experience auditing medical charts against itemized medical bills

PROFESSIONAL COMPETENCIES

• Communication - Must be able to express ideas clearly, concisely, and logically.  Must make effective and persuasive arguments when discussing medical care issues.
• Initiative – proactive in resolving problems, reporting discrepancies, suggesting new ideas and seeking process improvements.
• Judgment - use of good clinical judgment in resolving questions of medical necessity as it relates to precertifications and case management.
• Flexibility – must be willing to adjust as the industry or job requirements change.
• Teamwork – must work well in a team and help foster a cooperative environment.
• Represent a positive, professional image of the company.
• Excellent customer service skills and phone etiquette.
• Excellent organizational skills and attention to detail.

WORK CONDITIONS

• Office environment setting
• Able to work comfortably in a desk environment
• 90+% of the time spent sitting, doing keyboard entry and utilizing a mouse