Nurse Case Supervisor I

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As one of many world’s high Worldwide Medical Insurance coverage firms, IMG helps people and firms of all sizes. Each second of every single day, vacationers, these working or residing overseas for brief or prolonged intervals, individuals touring incessantly between international locations, and those that keep a number of international locations of residence use our merchandise to offer themselves world peace of thoughts® We wish to develop our groups with individuals who share our energy and enthusiasm for creating the most effective expertise for vacationers. JOB DETAILS RN License — Will need to have an energetic RN license in good standing in Indiana. Location: Hybrid or Distant working choices. Company workplace is in Indianapolis, IN. Relocation Bills Reimbursed: No Certified candidates should be legally licensed to be employed in the US. IMG is not going to be offering sponsorship for employment visa standing (e.g., H-1B or TN standing) for this place. JOB SUMMARY Consider medical necessity, appropriateness, and effectivity of using health care companies, procedures, and services for utilization overview and /or /evacuation/repatriation. Work as a liaison between the Insured, the insurance provider and the Insured’s healthcare group to fulfill the necessities of the Insured’s coverage in the US and overseas. PERKS Complete advantages bundle together with Medical/RX/Dental/Imaginative and prescient insurance 401k Plan with firm match Paid Time Off and Firm Paid Holidays Free worker parking On web site health middle Informal costume atmosphere Tuition reimbursement plan DUTIES AND RESPONSIBILITIES Carry out Certifications, Concurrent Evaluations, Retrospective Evaluations, and Medical Evacuations/Repatriations together with inpatient and outpatient management of help circumstances. Data of the Non-certification course of and Appeals course of together with logs and time frames. Take part within the on name rotation schedule. The supply of phone and e-mail primarily based pre travel recommendation Direct and/or re-direct members to in-network suppliers. Negotiate reductions with out of community suppliers. Direct healthcare group members to make the most of various care settings when acceptable. Establish potential giant case management circumstances by analysis, greenback quantity and/or excessive utilization of medical companies and refer these recognized for big case management. Doc info and standing in case management techniques and doc Put together precertification and/or case management studies as wanted. Use logic when evaluating medical circumstances and discuss with Medical Director when acceptable. Talk with different members of group as wanted, and be sure that info is shared appropriately. Keep confidentiality and privateness of all protected health info. Proceed education by related studying supplies, on-line programs and/or seminars. Help and take part in High quality Administration actions. Make the most of scientific assist instruments as indicated. Keep a working data of the any relevant state or federal rules as acceptable for job duties. Report/doc complaints when/if obtained. Every other job duties or duties as assigned. QUALIFICATIONS Present and energetic Nursing license – Registered Nurse Minimal two years acute hospital-based expertise offering direct patient care Good computer expertise together with familiarity with the Web, Phrase and Excel. PREFERRED SKILLS B.S.N. Most well-liked Minimal two years utilization overview with a managed care or insurance firm Proficient verbal and written communication skills in a overseas language most popular Wonderful computer expertise, together with database data. Expertise auditing medical charts in opposition to itemized medical payments PROFESSIONAL COMPETENCIES Communication – Should be capable of categorical concepts clearly, concisely, and logically. Should make efficient and persuasive arguments when discussing medical care points. Initiative – proactive in resolving issues, reporting discrepancies, suggesting new concepts and searching for course of enhancements. Judgment – use of excellent scientific judgment in resolving questions of medical necessity because it pertains to precertifications and case management. Flexibility – should be keen to regulate because the business or job necessities change. Teamwork – should work nicely in a group and assist foster a cooperative atmosphere. Symbolize a optimistic, skilled picture of the corporate. Wonderful customer service expertise and telephone etiquette. Wonderful organizational expertise and a focus to element. WORK CONDITIONS Workplace atmosphere setting In a position to work comfortably in a desk atmosphere 90 % of the time spent sitting, doing keyboard entry and using a mouse IMG is dedicated to creating a various atmosphere and is proud to be an equal alternative employer. All certified candidates will obtain consideration for employment with out regard to race, shade, ethnicity, nationwide origin, faith, gender, gender id or expression, sexual orientation, genetic info, incapacity, age, veteran standing, and different protected statuses as required by relevant law.
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