Nurse Case Supervisor I

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As one of many world’s prime Worldwide Medical Insurance coverage firms, IMG helps people and corporations of all sizes. Each second of day-after-day, vacationers, these working or dwelling overseas for brief or prolonged durations, individuals touring incessantly between nations, and those that preserve a number of nations of residence use our merchandise to present themselves world peace of thoughts® We need to develop our groups with individuals who share our energy and enthusiasm for creating the perfect 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 approved to be employed in the US. IMG won’t 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 the usage of health care providers, 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 crew to fulfill the necessities of the Insured’s coverage in the US 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 website health middle Informal costume atmosphere 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. 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 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 crew members to make the most of different care settings when acceptable. Determine potential massive case management instances by prognosis, greenback quantity and/or excessive utilization of medical providers and refer these recognized for giant case management. Doc data and standing in case management methods and doc Put together precertification and/or case management reviews as wanted. Use common sense when evaluating medical instances and discuss with Medical Director when acceptable. Talk with different members of crew as wanted, and be sure that data is shared appropriately. Keep 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 medical assist 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. Some 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 abilities together with familiarity with the Web, Phrase and Excel. PREFERRED SKILLS B.S.N. Most well-liked Minimal two years utilization evaluate with a managed care or insurance firm Proficient verbal and written communication skills in a international language most popular Glorious computer abilities, together with database data. Expertise auditing medical charts in opposition to itemized medical payments PROFESSIONAL COMPETENCIES Communication – Should be capable to 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 looking for 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 trade or job necessities change. Teamwork – should work nicely in a crew and assist foster a cooperative atmosphere. Symbolize a constructive, skilled picture of the corporate. Glorious customer service abilities and cellphone etiquette. Glorious organizational abilities and a spotlight to element. WORK CONDITIONS Workplace atmosphere setting Capable of 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, coloration, 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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