Salary: $60,000 - $70,000
Our client is a leader in the Medical Industry.Currently, they are looking for a Nurse Case Manager Bilingual (English & Spanish or French) to provide additional in-office and remote coverage in conjunction with their Case Management team.
The Nurse Case Manager assesses medical necessity, ensuring proper medical management of catastrophic cases, and assessing clinicals and required actions in medical emergencies.
Plans and reports on the development and performance of case management to ensure that there is the provision of local case management, as required.
Accountable for providing clinical support to the team while completing medical reviews, managing urgent admissions and emergency patient transfers in compliance with Client policies to ensure maximum quality of care and cost containment.
Maintains all records related to case management activity, financial processes, strategic plans and activities as it relates to the day to day operations.
Efficiently coordinates emergency medical evacuations according to client specific policies and company guidelines.
Coordinates patient care and medical treatment by directing patients to appropriate network facilities.
Provides medical management oversight to non-Nurse Case Managers.
Completes medical reviews by evaluating medical facts to determine if the treatment is medically necessary per client policy and is the most cost effective while maintaining quality of care.
Follows company guidelines in determining which medical reviews require review by Medical Director.
Evaluates insured eligibility status and benefits, while providing pre-certification authorization as required.
Sends benefit letters with network affiliation indicating the length of stay and the procedures that have been approved, as required.
Ensures treatment plans are appropriate for patients’ medical conditions.
Provides clinical assessment to determine medical necessity of air ambulance transfers and coordinates transfers as required.
Coordinates and communicates all relevant medical/benefit information to key stakeholders.
Operates as the liaison between the patient/family members, the client and the provider(s).
Completion of After Hours Tracking Sheet
Maintains comprehensive and accurate case notes and other relevant data.
Assesses suitability of length of stay, tests, and diagnostics as per published standards, standards of care according to geographic location and Medical Director.
Presents cost effective options for treatment to both the client and the insured.
Ensures treatment is delivered at the appropriate level of care (outpatient vs. inpatient).
Adheres to all policies and procedures as outlined in the Employee Handbook and client specific protocols.
Works in compliance with the Occupational Health and Safety Act and related legislation.
Performs all work in a PIPEDA and HIPAA compliant manner.
2+ years of nursing experience in a hospital or clinical setting.
Bilingual (English/Spanish) or (English/French)
Registered Nursing diploma or degree and in good standing with the College of Nurses (copy of license to be provided annually).
Excellent working knowledge of computer programs.
Superior verbal and written communication skills.
Critical and analytical thinking required.
Proficient and accurate data entry skills.
Assets (Nice to Have):
Experience in Medical Insurance industry.
Experience in Travel or Major Medical industry.
Experience with United States Medical system.
Experience with non-North American medical system.
Previous Case Management experience.
Ability to speak multiple languages.
Please Note: You will be working three 12 hour shifts per week (8pm-8am).
If you want to be part of an international success story and you are able to make a difference, then please send us your resume today!