Nurse Case Supervisor I

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As one of many world’s prime Worldwide Medical Insurance coverage corporations, IMG helps people and corporations of all sizes. Each second of day-after-day, vacationers, these working or dwelling overseas for brief or prolonged intervals, folks touring continuously between nations, and those that preserve a number of nations of residence use our merchandise to present themselves international peace of thoughts® We want to develop our groups with individuals who share our energy and enthusiasm for creating one of the best 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 have to be legally licensed to be employed in america. 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 assessment and /or /evacuation/repatriation. Work as a liaison between the Insured, the insurance provider and the Insured’s healthcare workforce to satisfy the necessities of the Insured’s coverage in america 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 gown surroundings Tuition reimbursement plan DUTIES AND RESPONSIBILITIES Carry out Certifications, Concurrent Opinions, Retrospective Opinions, 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 based mostly 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 different care settings when applicable. Determine potential giant case management instances by analysis, greenback quantity and/or excessive utilization of medical companies and refer these recognized for big case management. Doc data and standing in case management programs and doc Put together precertification and/or case management stories as wanted. Use logic when evaluating medical instances and check with Medical Director when applicable. Talk with different members of workforce as wanted, and be certain that data is shared appropriately. Preserve confidentiality and privateness of all protected health data. Proceed education by means of related studying supplies, on-line programs and/or seminars. Help and take part in High quality Administration actions. Make the most of scientific help instruments as indicated. Preserve a working data of the any relevant state or federal rules as applicable 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 assessment with a managed care or insurance firm Proficient verbal and written communication skills in a international language most popular Wonderful computer expertise, together with database data. Expertise auditing medical charts towards 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 fine scientific judgment in resolving questions of medical necessity because it pertains to precertifications and case management. Flexibility – have to be keen to regulate because the business or job necessities change. Teamwork – should work properly in a workforce and assist foster a cooperative surroundings. Symbolize a constructive, skilled picture of the corporate. Wonderful customer service expertise and cellphone etiquette. Wonderful organizational expertise and a focus to element. WORK CONDITIONS Workplace surroundings setting Capable of 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, shade, ethnicity, nationwide origin, faith, gender, gender id or expression, sexual orientation, genetic data, incapacity, age, veteran standing, and different protected statuses as required by relevant law.
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