Confidential

Confidential

Indianapolis, IN

Nurse Case Manager

$65,000-$75,000 / YEAR
  • RN active
  • Must have Acute care in background ( 2 years )
  • Outside the box thinker to work with clients and claims
  • Company will train to be a Case Manager: training in person in Indy
  • Team of RN Case Managers works closely together
  • On call rotations one every 6-7 weeks works from home when on call
  • Maybe remote later but not right now. All training in person at home office. Plan on being at the home office for the future until more seasoned.
  • Company paid Parking as they are located across from the Indianapolis Children’s Museum.
  • PREFERRED SKILLS

    • Bachelor of Science in Nursing is preferred but not required
    • Experience in utilization review, case management, or large case management functions with a managed care or insurance company preferred
    • Experience with auditing medical charts against itemized medical bills.
    • Certified Case Manager preferred (CCM)
    • Proficient verbal and written communication skills in a foreign language a plus
    • Active membership in a professional association related to nursing a plus

    PERKS

    • Comprehensive benefits package including Medical/RX/Dental/Vision insurance
    • 401k Plan with company match
    • On site fitness center
    • Casual dress environment
    • Tuition reimbursement plan
  • Job RequirementsDUTIES AND RESPONSIBILITIES

  • Perform Certifications, Concurrent Reviews, Retrospective Reviews, Medical Evacuations, and Large Case Management.
  • Determine and develop case management care plans with short and long-term goals that are action oriented and time specific designed to meet the insured’s needs
  • Monitor treatment, outcomes and care plan, suggesting alternate care settings when appropriate and evaluating and updating goals as needed
  • Act as an advocate and provides ongoing health education when necessary.
  • Knowledge of Non-certification process and Appeals process including logs and time frames.
  • Review medical services for medical necessity.
  • 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.
  • Review medical information for large case management.
  • Consult medical criteria and other medical resources as needed.
  • Document information and status in ACM systems and documents.
  • Participate in the on-call rotation schedule.
  • 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.
  • Remain current on regulations and legislation that affect utilization review functions.
  • 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 Core and Utilization Management standards established by URAC and 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

    • Active State of Indiana license as a Registered Nurse in good standing
    • Minimum two (2) years of acute hospital-based experience providing direct patient care
    • Experience using medical criteria as an aid to decision-making
    • Good computer skills including working knowledge of the Internet and Microsoft Office (e.g. Word and Excel)
    • Excellent customer service skills and phone etiquette.
    • Excellent organizational skills and attention to detail.
    • Excellent written and oral communication skills – Must be able to express ideas clearly, concisely, and logically.  Must make effective and persuasive arguments when discussing medical care issues while representing a positive, professional image of the company
    • Initiative – proactive in resolving problems, reporting discrepancies, suggesting new ideas and seeking process improvements.
    • Judgment – use of good clinical judgment as it relates to medical treatment in 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.