Our client is a leader in the Medical Industry. Currently, they are looking for a Nurse Case Manager – Bilingual (English & Spanish) 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.
- Maintains all records related to case management activity, financial processes, strategic plans and activities as it relates to the day to day operations.
- Coordinates patient care and medical treatment by directing patients to appropriate network facilities.
- Provides medial management oversight to non-RN Travel Nurses.
- Reviews medical facts to determine if the treatment is medically approved per client policy and is the most cost effective while maintaining quality of care.
- 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.
- 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 including presentations at rounds when applicable.
- Manages a case from inception through completion of treatment.
- Operates as the liaison between the patient/family members, the client and the provider(s).
- Maintains comprehensive and accurate case notes, cost estimates and other relevant data.
- Identifies cases ready for closure and completes applicable procedures.
- Responsible for rotational nurse-on-call.
- Assesses suitability of length of stay, tests, and diagnostics as per published standards 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).
- Identifies and coordinates arbitration opportunities to reduce costs of treatment.
- Responsible to prepare and send large loss client reports twice a week.
- Ensures own knowledge and educates team members on the importance of fiscal responsibility and/or “knowing the deal” when managing cases/claims.
- Adheres to all policies and procedures as outlined in the Employee Handbook and client specific protocols.
- Performs all work in a PIPEDA and HIPAA compliant manner.
- Works in compliance with the Occupational Health and Safety Act and related legislation.
- Other related duties as assigned.
- Bilingual (English and Spanish).
- 2+ years of nursing experience in a hospital or clinical setting.
- 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 twelve-hour shifts some weeks and 4-5 (9 hour shifts) on others.
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!
To apply for this position please forward your resume as an MS Word attachment to: firstname.lastname@example.org
If you have already been in contact with a consultant from Bilingual Recruiters, please contact them directly to confirm your interest in this position.
Due to the high volume of resumes received please be advised only those selected for an interview will be contacted. No phone calls please.