Case Management Registered Nurse

    • Job Tracking ID: 512935-582103
    • Job Location: Meridian, ID
    • Job Level: Mid Career (2+ years)
    • Level of Education: 2 year degree
    • Job Type: Full-Time/Regular
    • Date Updated: July 06, 2017
    • Years of Experience: 2 - 5 Years
    • Starting Date: August 28, 2017
    • Salary Type:: Salary
    • Rate:: $52,000 - $60,000 (Depends on Experience)
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Job Description:

Are you ready for a new career path?

Do you want to land a more fulfilling job than the one you're in now?

Are you looking for a company that values integrity, initiative, good judgment and teamwork?

As a part of our continued growth, we are searching for the right individual to join our team!

We are looking for individuals with a strong desire to embrace and represent our unique culture founded on our Core Values of Integrity, Initiative, Good Judgment and Teamwork and our passion for changing lives through leadership development.

AmeriBen is a leader in the benefits administration industry with a strong track record for consistent double-digit growth (doubling every five years for the past 30 years). We are experiencing wonderful nationwide growth and need effective, dynamic leaders with good values to help us continue this momentum.

There's an energy and excitement here, an opportunity to work with a diverse culture while sharing a goal to improve the lives of others, as well as our own. The result is a culture of performance that's driving the health care industry forward.

If you are an RN with a passion for helping people succeed in managing their health, our position may be for you. The AmeriBen Medical Management team provides utilization management, case and disease management services to thousands of members navigating the complex world of healthcare. You have the chance to change lives with the benefits of a salaried position combined with a work-life balance!

Case management includes planning, coordinating, implementing, monitoring and evaluating the medical services required to meet the complex health needs of our members, while cost-effectively achieving desired clinical outcomes and enhancing the quality of medical care. It is characterized by advocacy, communication, and resource management, while promoting quality and cost-effective interventions and outcomes. The case manager's role includes contact with the participant and/or provider(s), coordination of services within the health care arena, and utilization of internal guidelines/criteria to determine medical necessity and to coordinate care.

Key Result Areas

  • Establish contact with member and family members.
  • Assess the member's current status, prognosis, future care needs, treatment plan and alternative treatment plans.
  • Conduct precertification services including prospective, concurrent and retrospective review, using internal guidelines and criteria, nursing judgment and physician advisor review.
  • Work closely with providers to ensure appropriate utilization of services and effective cost management.
  • Develop and implement individualized member care plans.
  • Evaluate effectiveness of care plan and progress made by member.
  • Initiate appropriate cost effective recommendations.
  • Capture and record any cost savings.
  • Act as a liaison between referral source, physician and member.
  • Facilitate appropriate transition of care and discharge planning.
  • Coordinate care with Utilization Management staff.
  • Identify and refer appropriate cases to the Disease Management department.
  • Perform Post Hospitalization Calls
  • Maintain appropriate documentation of all cases.
  • Maintain confidentiality of records and information.
  • Maintain and report applicable statistics regarding programs and patient services.
  • Attend weekly on-site team meetings and monthly staff meetings.
  • Perform all duties within the scope of her/his licensure.
  • After six months of demonstrated efficiency in position, working from home may be possible.

Experience and Skills:

Minimum Qualifications

  • Current unrestricted Idaho RN license
  • Associates Degree in Nursing (Bachelor Degree is a plus)
  • Diverse clinical experience with Certification in Utilization Management or Case Management preferred.
  • Understanding of Case Management functions, self-funded insurance plans and PPO networks.
  • Knowledge of medical/health insurance terminology, ICD-9/ICD-10, HIPAA and DOL regulations.
  • Type 45 words per minute
  • Intermediate level experience in Microsoft Word, Excel, Outlook, and Power Point.
  • Strong interpersonal relationship skills and the ability to work effectively with a diverse patient population.
  • Ability to communicate effectively, both verbally and in writing, medical information to health care professionals, employer groups, Brokers, stop loss personnel, internal customers, members and families.
  • Ability to work independently under general instruction and with a team.
  • Time management, organizational, research, analytical, and documentation skills.
  • Negotiation skills.
  • Ability to work efficiently, perform multi-tasking, prioritize tasks, and meet tight deadlines.
  • Ability to efficiently and effectively perform the Essential Key Result Areas with or without a reasonable accommodation without posing a direct safety threat to others or self.
  • Protect and enhance the Core Purpose and the Core Values of the AmeriBen/IEC Group.