You haven't searched anything yet.
Why work with us?
The North American branch of Generali Global Assistance offers a diverse and inclusive work environment while employees work towards making real difference in the lives of our clients. As an Organization, we pride ourselves with offering white glove service while being mindful of corporate responsibility and our environmental footprint.
Employees enjoy a plethora of benefits to include:
Who are we?
Generali Global Assistance is proudly part of the Europ Assistance Group brand and our products utilize a number of corporate and product brands. The brands for our North American team include the following:
What youll be doing.
Job Summary:
The Medical Case Manager is a Licensed Practical Nurse or a Registered Nurse who is accountable and capable of securing and reviewing clinical data in order to approve requests for admissions, procedures and services that meet clinical review criteria. Ensures that there is coordination and delegation of care between all providers involved. Ensure that procedures / services are not duplicated and that services being rendered fall within the industry standards of care. The Medical Case Managers responsibilities include but are not limited to: assessment of strengths and weaknesses, implementation of a treatment plan, coordination and availability of resources, familiarity with the insured policy and its limitations and the communication and documentation with the appropriate entities that require information as per the stated policies and procedures while adhering to HIPAA and/or GDPR compliance. The Medical Case Manager (UR/UM/CM) is NOT financially incentivized for decisions that result in underutilization, adverse determinations and / or denials.
Principal Duties and Responsibilities:
Performs UR/UM and Case Management duties according to company policy and procedure.
Collects client data and conducts emergent and non-emergent clinical assessment.
Assists in the referral of patients to most appropriate provider specialty / facility within Network.
Monitors and screens pre-authorization requests for second medical opinion referrals and/or diagnostic testing.
Reviews hospital admissions for medical necessity and assigns LOS in accordance with established criteria.? Sends out appropriate communication to providers, facilities and/or client.
Refers all cases that do not fall within pre-established criteria to the Supervisor for further evaluation and determination of admission approval, procedure or services requested or refer to Medical Director or peer reviewer.
Medical Case Managers do not issue non-certifications (denials). Once it is determined that an admission, procedure or service should be denied; assists in assuring that verbal or written denial notices are distributed out to the appropriate parties in a timely manner.
Performs duties of the discharge planning nurse to contain LOS and assure that the insured (member/patient) is receiving services within the 6 Rights: Care, Place, Time, Provider, Price and Outcome.
Assist with the coordination (within all phases) of a repatriation /evacuation and work in accordance to individual Client Procedures as well as internal GMMI Work Instructions and/or Standard Operating Procedures.? Report any change in insureds (member/patient) condition IMMEDIATELY in order to make any differing change in plans.
Enters and maintains all applicable information related to a case in GMMIs operating software.
Attends and participates in all departmental meetings as scheduled. Coordinates data collection and reporting for meetings, as deemed appropriate.
Evaluates and reviews treatment plan for consistency of care.? Develops realistic treatment plan in conjunction with provider recommendations in order to meet the clients needs while providing the most appropriate and cost effective method of delivering services.
Performs written and oral communication with other GMMI staff to provide case information, recommendations based on medical necessity and policy language and cost indexes to clients.
Evaluates and determines the availability of resources in conjunction with policy limits and coverage. Implements cost management and delivers the most effective treatment plan.
Maintains current knowledge base with regard to medical-surgical cases, utilization management, discharge planning and continued care needs in relation to physician approved criteria. Case Manager is to expand knowledge base and become familiar with ICD-10 and how it improves cost containment efforts due to specificity.
Reports concerns, problems, and quality assurance issues with the correct Department Head for further evaluation and possible intervention. Follows up with corrective action on recommendations made when required.
Responsible for updating the Tracker system and for the timely follow up on each case that is monitored in the tracker.
Participates in issuing non-conformance and corrective actions as per ISO policy when quality issues or disruptions in services or systems are identified (always think proactively).? Mindset: How can I improve the process and / or the outcome
Functions as a clinical resource to non-clinical staff.
Required / Desired Knowledge, Experiences and Skills:
Requirements:
Prior to being employed by GMMI, Medical Case Managers need to possess at least two-year experience in the field of Managed Care or related acute care areas; Medical/Surgical, OB/GYN, Pediatrics, Cardiology, Neurology, Nephrology, Orthopedics, Transplant and/or CCU/ICU.
Maintains confidentiality of all pertinent client/member (patient) information.
Basic to moderate computer literacy required
Basic to moderate typing competency required
Strong organizational and time management skills required with emphasis on prioritizing and performing multiple tasks in unison.
Excellent communication skills (verbal and written).
Effective and sound decision making and problem solving skills a must.
Ability to work both independently and in a group setting.
Exercises and displays the ability to interact effectively with physicians, providers, internal staff and insureds as deemed necessary.
Able to work in a multicultural environment and manage a diverse client / patient population is required.
Preferred:
Bilingual (any language)
Education/Certifications:
Requirements:
High School Diploma or Equivalent (GED) required.
Licensed health professionals: LPN or RN. Active license in the state of Florida.
Keep license current and complete CEUs as mandated by the Board of Nursing in the state of Florida http://floridasnursing.gov/.
Physical Working Environment:
While performing the duties of this job, the employee is required to stand; walk; sit for long periods of time; use of hands to grasp, handle, or feel; reach with hands and arms; finger dexterity; talk; hear. The employee is occasionally required to climb or balance and stoop, kneel, crouch, or crawl. The employee must frequently lift and/or move up to ten pounds and occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this job include close vision, distance vision, peripheral vision, depth perception and ability to adjust focus.
The above statements are intended to describe the general nature of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all responsibilities, duties and skills required of employees so classified.
Where youll be doing it.
This is a hybrid role based out of our Pembroke Pines, FL office. As a hybrid role, you will be working onsite 5 days one week and working from home 5 days the following week (alternating).
When youll be doing it.
While there is some flexibility in the hours, this position will be Monday-Friday during regular business hours (approximately 8:00am-5:00pm). Occasional overtime may be required according to business need. On-call weekends may be required.
Apply today to begin your next chapter.
Dont meet every single requirement? At Generali Global Assistance, we are dedicated to building a diverse, inclusive and enriching workplace, so if youre excited about this role but your past experience doesnt align perfectly with every qualification in the job description, we encourage you to apply anyways. You may be just the right candidate for this or other roles.
The Company is committed to providing equal employment opportunity in all our employment programs and decisions. Discrimination in employment on the basis of any classification protected under federal, state, or local law is a violation of our policy. Equal employment opportunity is provided to all employees and applicants for employment without regard age, race, color, religion, creed, sex, gender identity, gender expression, transgender status, pregnancy, childbirth, medical conditions related to pregnancy or childbirth, sexual orientation, national origin, ancestry, ethnicity, citizenship, genetic information, marital status, military status, HIV/AIDS status, mental or physical disability, use of a guide or support animal because of blindness, deafness, or physical handicap, or any other legally protected basis under applicable federal, state, or local law. This policy applies to all terms and conditions of employment, including, but not limited to, recruitment and hiring, classification, placement, promotion, termination, reductions in force, recall, transfer, leaves of absences, compensation, and training. Any employees with questions or concerns about equal employment opportunities in the workplace are encouraged to bring these issues to the attention of Human Resources. The Company will not allow any form of retaliation against individuals who raise issues of equal employment opportunity. All Company employees are responsible for complying with the Companys Equal Opportunity Policy. Every employee is to treat all other employees equally and fairly. Violations of this policy may subject an employee to disciplinary action, up to and including termination of employment.
Full Time
$82k-99k (estimate)
04/03/2024
05/08/2024
globalmedicalmgmt.com
Oklahoma City, OK
<25
The job skills required for Medical Case Manager include Case Management, Coordination, Problem Solving, Acute Care, Confidentiality, Discharge Planning, etc. Having related job skills and expertise will give you an advantage when applying to be a Medical Case Manager. That makes you unique and can impact how much salary you can get paid. Below are job openings related to skills required by Medical Case Manager. Select any job title you are interested in and start to search job requirements.
The following is the career advancement route for Medical Case Manager positions, which can be used as a reference in future career path planning. As a Medical Case Manager, it can be promoted into senior positions as a Case Management Director that are expected to handle more key tasks, people in this role will get a higher salary paid than an ordinary Medical Case Manager. You can explore the career advancement for a Medical Case Manager below and select your interested title to get hiring information.
If you are interested in becoming a Medical Case Manager, you need to understand the job requirements and the detailed related responsibilities. Of course, a good educational background and an applicable major will also help in job hunting. Below are some tips on how to become a Medical Case Manager for your reference.
Step 1: Understand the job description and responsibilities of an Accountant.
Quotes from people on Medical Case Manager job description and responsibilities
Coordinating and providing care that is safe, timely, effective, efficient, equitable, and client-centered.
03/10/2022: Bangor, ME
Medical case managers are responsible in handling case assignments, draft service plans, review case progress and determine case closure.
03/20/2022: Mcallen, TX
A medical case manager connects a client to patient-centered services related to their treatment plans.
03/26/2022: Portsmouth, NH
They help patients make informed decisions by acting as their advocate regarding their clinical status and treatment options.
03/10/2022: Columbia, SC
Record cases information, complete accurately all necessary forms and produce statistical reports.
03/01/2022: Wichita Falls, TX
Step 2: Knowing the best tips for becoming an Accountant can help you explore the needs of the position and prepare for the job-related knowledge well ahead of time.
Career tips from people on Medical Case Manager jobs
There are many paths to becoming a case manager, with options to transition from other related healthcare professions, such as nursing and social work.
03/11/2022: Lincoln, NE
Most states require an official certification to work as a case manager.
04/14/2022: Carson City, NV
Patients can also trust case managers who show empathy.
04/06/2022: Rochester, NY
Certification determines that the case manager possesses the education, skills and experience required to render appropriate services based on sound principles of practice.
03/17/2022: Nashua, NH
Adhere to professional standards as outlined by protocols, rules and regulations.
04/09/2022: Burlington, VT
Step 3: View the best colleges and universities for Medical Case Manager.