Position: Case Manager
Client: Health Insurance Client
Location: Remote (Indiana)
Duration: 6-month Contract-to-Hire
Start: ASAP
Overview:
The RN Case Manager plans and coordinates care for patients from pre-admission through post-discharge by working collaboratively with the multidisciplinary team. Ensures that patients are assigned the appropriate level of care, receive the appropriate services and are transitioned to the appropriate post-discharge level of care. Performs accurate, timely and effective discharge planning for patients. Works with third party payers to ensure coverage. Administers education and prevention programs.
Qualifications:
- Associate's Degree in Nursing or Bachelor's Degree in Social Work required.
- Requires an active Registered Nurse (RN) license in the state of Indiana or an active Nurse Licensure Compact (NLC) RN license OR a Social Work license in the state of Indiana.
- Certification in Case Management preferred.
- Knowledge of InterQual Acute Level of Care Criteria and Federal guidelines outlining coverage of inpatient and outpatient hospital services, including observation is preferred.
- Knowledge of Medicare/Medicaid, insurance and regulatory guidelines is preferred.
- Ability to comprehend third party contractual arrangements is preferred.
- Understanding of the third party denial and appeal process is preferred.
- Requires knowledge of various software applications including Windows; Cerner; MCCM; and SMS.
- 3-5 years of experience preferred.
Job Type: Full-time
Benefits:
- Dental insurance
- Health insurance
- Vision insurance
Schedule:
- 8 hour shift
- Monday to Friday
Work setting:
Application Question(s):
- Do you have a valid Indiana RN license or Compact State RN License?
- Do you have a valid Social Work license in the state of Indiana? Please state which license you currently hold.
- How many years of Health Insurance Industry/Managed Care experience do you have?
Experience:
- Case management: 3 years (Preferred)
- InterQual: 1 year (Preferred)
- Milliman (MCG): 1 year (Preferred)
- Cerner: 1 year (Preferred)
Location:
Work Location: Remote