A leading national Managed Care Organization is seeking a Case Manager for their location in New York.
Remote employees must live in New York Tri-state region
Education
REQUIRED SKILLS AND QUALIFICATIONS
Registered Nursing Degree required; Bachelor’s Degree in Nursing preferred; Case Management Certificate preferred.
Experience
Minimum of 2 years of Medical Case Management experience.
Minimum of 1 year of Public Health experience.
Minimum of 2 years of critical care and/or med-surg experience.
Knowledge of applicable state, federal, and third-party regulations and standards (Background in discharge planning and home health).
Special Skills Or Knowledge
Knowledge of a variety of clinical areas of medical treatment.
Familiarity with hospital/patient care facilities, current practices, procedures, acceptable medical treatment, and diagnoses.
Ability to learn company policies and procedures related to hospital authorization/denials, physician review, appeals, etc.
Ability to apply established guidelines and regulations to specific and individual situations.
Strong oral and written communication skills to ensure accurate transfer of information and build rapport.
Proficiency in establishing and maintaining a variety of records necessary for providing complete information and documentation for relevant medical determinations.
Ability to establish and maintain effective work relationships with various stakeholders.
Proficiency with PC-based computer systems and ability to learn new information systems and software.
Excellent organizational skills.
Licensure/Certification
Valid New York State Registered Nursing license (BSN preferred).
Capability of transporting self to various locations. If operating a motor vehicle, must have a valid New York Driver’s license; if using own vehicle, must have proof of insurance coverage that at least meets current State minimum requirements.
Certified Case Manager (CCM) Certification preferred.
This is an open-ended assignment and a great opportunity to join a national organization.
Employment type
Full-time
Job function
Other
Industries
Staffing and Recruiting
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