Case Manager-Remote

Company Overview

Boon-Chapman is not your average Third Party Administrator. In addition to traditional TPA services, Boon-Chapman administers business process outsourcing for insurance entities, and other services through its sister companies. With nearly 55 years in business, Boon-Chapman combines the legacy of a family-owned-and-operated company, with the energy and potential of a fast-growing enterprise of companies. A few of our benefits include:

• Paid holidays & competitive PTO that increases with tenure
• Full benefits package including healthcare, dental, vision, paid STD & life
• Casual everyday dress
• Work from home opportunities
• Unlimited opportunities for growth – success is in your own hands!

Job Overview

Seeking an individual to manage the patient's health status across the continuum of care for Prime Dx. The Case Management staff position serves as a member of the care management team. As a Case Manager (CM), the staff member will be expected to assess, plan, implement, coordinate, monitor and evaluate the treatment options of health care services that are clinically appropriate in a timely manner. This position is a remote position with onsite training in Austin.  Reports to the Director of Medical Management.

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  Assist in meeting the patient’s needs by promoting quality, cost effective outcomes.
• Follow the core components of the case management process by being able to coordinate and assure the delivery of service, assess physical as well as psychological factors involved in planning the patient’s care, evaluation of the benefits and calculate a cost benefit analysis.
• Be knowledgeable in regards to community resources and apply the case management concepts and standards of care.
• Strong skills in communication, empowerment, facilitation, collaboration, problem solving, as well as being an advocate to the client.
• Internal policies and procedures.
• Strong working knowledge of current health care protocols with emphasis on oncology and transplant.
• Must be able to properly interpret plan documents for utilization review, case management and health care elements.
• Core components of the case management process.
• Performs telephonic case management.
• Identify and initiate discharge planning for clinically complex patients.
• Identify and evaluate members’ needs via telephone communication, claims data, referrals or any methodology excluding face-to-face interaction.
• Interface with providers, families and alternative resources to identify and coordinate care.
• Review all open cases dependent upon their priority and status level.
• Document all case management activities and/or interventions for applicable members as they occur.
• Act as a resource for internal and external customers.
• Assume accountability for coordination and management of the assigned case until time of closure.
• Educate member and family, and coordinate with providers regarding community resources and alternate funding sources as appropriate.
• Continue to monitor and evaluate case activities and revise plan of care as needed.
• Act as an advocate for the member in the healthcare delivery system.
• Develop, implement and maintain case management care plans for complex and/or large cases.
• Direct claims, benefit, and eligibility inquiries.
• Communicate with physician advisor on any inpatient/outpatient stays, services, or procedures that are believed to be questionable in any way.
• Maintains client and subscriber confidentiality at all times.
• Other tasks/duties as assigned.

Experience and Education

• Current RN/LVN license in State of Texas.
• Certified Case Manager (preferred).
• Five years medical/surgical/hospital/outpatient experience.
• Experience with case and/or disease management.
• Organizational skills, self motivated, work independently Experience with ICD-10 and/or CPT codes (preferred).
• Computer skills.
• Demonstrate leadership skills.
• Excellent oral and written communication skills.