A leading national Managed Care Organization is seeking a Case Manager for their location in New York.
Remote employees must live in New York Tri-state region
REQUIRED SKILLS AND QUALIFICATIONS
Education:
- Registered Nursing Degree required; Bachelor’s Degree in Nursing preferred; Case Management Certificate preferred.
Experience:
- Minimum of 2 years of Medical Case Management experience.
- Minimum of 1 year of Public Health experience.
- Minimum of 2 years of critical care and/or med-surg experience.
- Knowledge of applicable state, federal, and third-party regulations and standards (Background in discharge planning and home health).
Special Skills or Knowledge:
- Knowledge of a variety of clinical areas of medical treatment.
- Familiarity with hospital/patient care facilities, current practices, procedures, acceptable medical treatment, and diagnoses.
- Ability to learn company policies and procedures related to hospital authorization/denials, physician review, appeals, etc.
- Ability to apply established guidelines and regulations to specific and individual situations.
- Strong oral and written communication skills to ensure accurate transfer of information and build rapport.
- Proficiency in establishing and maintaining a variety of records necessary for providing complete information and documentation for relevant medical determinations.
- Ability to establish and maintain effective work relationships with various stakeholders.
- Proficiency with PC-based computer systems and ability to learn new information systems and software.
- Excellent organizational skills.
Licensure/Certification:
- Valid New York State Registered Nursing license (BSN preferred).
- Capability of transporting self to various locations. If operating a motor vehicle, must have a valid New York Driver’s license; if using own vehicle, must have proof of insurance coverage that at least meets current State minimum requirements.
- Certified Case Manager (CCM) Certification preferred.
This is an open-ended assignment and a great opportunity to join a national organization.