Case Manager / RN (Bilingual)

At MedWatch, LLC., a Most Loved Workplace® certified employer in the Hospital & Health Care space, Reshaping Healthcare with Compassion, Innovation, and Integrity.

Manage an individual caseload using the case management process to meet MedWatch customers’ and consumers’ needs. Authorize services and review treatment plans for medical necessity and standards of care. Maintain ongoing communication with patients, caregivers, providers, payers, and the healthcare team. Review medical data and establish, update, and maintain case management plans. Assess patient problems and document goals, actions, interventions, and case notes. Verify benefit constraints with payer offices. Contact medical care providers and equipment vendors to verify medical necessity. Arrange quality patient care according to patient needs, physician orders, and available benefits. Manage case management files and maintain responsibility for the case management file. Identify alternative treatments and provide cost-benefit analyses for extra-contractual services when appropriate. Use community resources and funding sources to support patient care and conserve benefit dollars. Maintain case actions and billing in the computer system. Prepare timely reports to payers detailing case actions, results, and continuing plans. Maintain contact across the continuum of care and monitor chronic-condition cases. Negotiate with providers to maximize medical benefits and make network referrals. Address patient safety or welfare issues and direct patients or families to appropriate resources or authorities. Consult regularly with the CM supervisor and report complaints or issues beyond the case manager’s expertise. Adhere to company policies and participate in the Quality Management Program.

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