IMG is committed to creating a diverse environment and is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, ethnicity, national origin, religion, gender, gender identity or expression, sexual orientation, genetic information, disability, age, veteran status, and other protected statuses as required by applicable law.
As one of the world's top International Medical Insurance companies, IMG helps individuals and companies of all sizes. Every second of every day, vacationers, those working or living abroad for short or extended periods, people traveling frequently between countries, and those who maintain multiple countries of residence use our products to give themselves global peace of mind®
We are looking to grow our teams with people who share our energy and enthusiasm for creating the best experience for travelers.
Nurse Case Managers evaluate medical necessity, appropriateness, and efficiency of the use of health care services, procedures, and facilities for utilization review. They work as a liaison between the Insured, the insurance carrier and the Insured’s healthcare team to meet the requirements of the Insured’s policy in the United States and abroad.
DUTIES AND RESPONSIBILITIES
- Perform Certifications, Concurrent Reviews, Retrospective Reviews, and Medical Evacuations.
- Knowledge of the Non-certification process and Appeals process including logs and time frames.
- Review medical services for medical necessity.
- Direct and/or re-direct members to in-network providers.
- Negotiate discounts with out of network providers.
- Direct healthcare team members to utilize alternative care settings when appropriate.
- Identify potential large case management cases by diagnosis, dollar amount and/or high utilization of medical services and refer those identified for large case management.
- Document information and status in ACM systems and documents.
- Participate in the on-call rotation schedule.
- Prepare precertification and/or case management reports as needed.
- Use good judgment when evaluating medical cases and confer with Medical Director when appropriate.
- Communicate with other members of team as needed and ensure that information is shared appropriately.
- Maintain confidentiality and privacy of all protected health information.
- Continue education through relevant reading materials, online courses and/or seminars.
- Support and participate in Quality Management activities.
- Utilize clinical support tools as indicated.
- Maintain a working knowledge of the Core and Utilization Management standards established by URAC and any applicable state or federal regulations as appropriate for job duties.
- Report/document complaints when/if received.
- Any other job duties or tasks as assigned.
EDUCATION / LICENSE / CERTIFICATION REQUIREMENTS
- Current and active Indiana Nursing license - Registered Nurse
- B.S.N. preferred
- Minimum two (2) years hospital-based experience providing direct patient care.
- Minimum two (2) years utilization review with a managed care or insurance company.
- Good computer skills including familiarity with the Internet, Word and Excel.
- Proficient verbal and written communication skills in a foreign language preferred
- Excellent computer skills, including database knowledge.
- Experience auditing medical charts against itemized medical bills
- Communication - Must be able to express ideas clearly, concisely, and logically. Must make effective and persuasive arguments when discussing medical care issues.
- Initiative – proactive in resolving problems, reporting discrepancies, suggesting new ideas and seeking process improvements.
- Judgment - use of good clinical judgment in resolving questions of medical necessity as it relates to precertifications and case management.
- Flexibility – must be willing to adjust as the industry or job requirements change.
- Teamwork – must work well in a team and help foster a cooperative environment.
- Represent a positive, professional image of the company.
- Excellent customer service skills and phone etiquette.
- Excellent organizational skills and attention to detail.
- Must be willing to work a schedule of Monday - Friday from 9:00 AM - 6:00 PM (EST).
- Must be willing to work rotational on-call weekends based on business needs (generally once every 9 weeks but subject to change based on business needs)
- Must be willing to work an occasional Holiday
- Office environment setting
- Able to work comfortably in a desk environment
- 90+% of the time spent sitting, doing keyboard entry and utilizing a mouse.
- Comprehensive benefits package including Medical/RX/Dental/Vision insurance
- 401k Plan with company match
- On site fitness center
- Casual dress environment
- Tuition reimbursement plan
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, national origin, disability or veteran's status.
Applicants with a disability or a disabled veteran may request a reasonable accommodation if he/she is unable or limited in his/her ability to access job openings or apply for a job on our website as a result of his/her disability. The applicant may request reasonable accommodations by contacting us at 317.340.4154.