Nurse Case Supervisor I

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As one of many world’s high Worldwide Medical Insurance coverage corporations, IMG helps people and firms of all sizes. Each second of on daily basis, vacationers, these working or residing overseas for brief or prolonged intervals, folks touring steadily between international locations, and people who keep a number of international locations of residence use our merchandise to offer themselves international peace of thoughts® We wish to develop our groups with individuals who share our energy and enthusiasm for creating the very best expertise for vacationers. JOB DETAILS RN License — Will need to have an lively 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 approved to be employed in the USA. 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 amenities for utilization evaluation and /or /evacuation/repatriation. Work as a liaison between the Insured, the insurance service and the Insured’s healthcare workforce to satisfy the necessities of the Insured’s coverage in the USA 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 website health heart Informal gown surroundings 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 instances. 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 workforce members to make the most of various care settings when applicable. Determine potential massive case management instances by prognosis, greenback quantity and/or excessive utilization of medical companies and refer these recognized for giant case management. Doc info and standing in case management techniques and doc Put together precertification and/or case management experiences as wanted. Use common sense when evaluating medical instances and talk to Medical Director when applicable. Talk with different members of workforce as wanted, and make sure that info is shared appropriately. Keep confidentiality and privateness of all protected health info. Proceed education via related studying supplies, on-line programs and/or seminars. Help and take part in High quality Administration actions. Make the most of medical assist instruments as indicated. Keep a working information of the any relevant state or federal laws as applicable for job duties. Report/doc complaints when/if obtained. Every other job duties or duties as assigned. QUALIFICATIONS Present and lively Nursing license – Registered Nurse Minimal two years acute hospital-based expertise offering direct patient care Good computer abilities together with familiarity with the Web, Phrase and Excel. PREFERRED SKILLS B.S.N. Most popular Minimal two years utilization evaluation with a managed care or insurance firm Proficient verbal and written communication skills in a international language most well-liked Wonderful computer abilities, together with database information. Expertise auditing medical charts in opposition to itemized medical payments PROFESSIONAL COMPETENCIES Communication – Should be capable of specific 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 in search of course of enhancements. Judgment – use of fine medical 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 effectively in a workforce and assist foster a cooperative surroundings. Symbolize a optimistic, skilled picture of the corporate. Wonderful customer service abilities and cellphone etiquette. Wonderful organizational abilities and a focus to element. WORK CONDITIONS Workplace surroundings setting In a position to work comfortably in a desk surroundings 90 % of the time spent sitting, doing keyboard entry and using a mouse IMG is dedicated to creating a various surroundings and is proud to be an equal alternative employer. All certified candidates will obtain consideration for employment with out regard to race, coloration, ethnicity, nationwide origin, faith, gender, gender identification or expression, sexual orientation, genetic info, incapacity, age, veteran standing, and different protected statuses as required by relevant law.
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