Nurse Case Supervisor I

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As one of many world’s high Worldwide Medical Insurance coverage corporations, IMG helps people and corporations of all sizes. Each second of daily, vacationers, these working or residing overseas for brief or prolonged durations, folks touring continuously between nations, and people who preserve a number of nations of residence use our merchandise to provide themselves international 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 — Should 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 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 services for utilization evaluate 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 package deal 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 setting 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 circumstances. Information 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 availability of phone and electronic 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 acceptable. Establish potential massive case management circumstances 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 programs and doc Put together precertification and/or case management experiences as wanted. Use logic when evaluating medical circumstances and check with Medical Director when acceptable. Talk with different members of workforce 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 help instruments as indicated. Keep a working data of the any relevant state or federal laws as acceptable for job duties. Report/doc complaints when/if obtained. Another 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 abilities together with familiarity with the Web, Phrase and Excel. PREFERRED SKILLS B.S.N. Most popular Minimal two years utilization evaluate with a managed care or insurance firm Proficient verbal and written communication skills in a international language most well-liked Glorious computer abilities, together with database data. Expertise auditing medical charts towards itemized medical payments PROFESSIONAL COMPETENCIES Communication – Should have the ability to 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 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 trade or job necessities change. Teamwork – should work nicely in a workforce and assist foster a cooperative setting. Symbolize a constructive, skilled picture of the corporate. Glorious customer service abilities and telephone etiquette. Glorious organizational abilities and a spotlight to element. WORK CONDITIONS Workplace setting setting In a position to work comfortably in a desk setting 90 % of the time spent sitting, doing keyboard entry and using a mouse IMG is dedicated to creating a various setting 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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