Case Manager - RN
Health Care | Columbia, SC | Temp to Perm
Case Manager / RN
InGenesis Solutions has an exciting opportunity for an RN / Case Manager to come work with our client located in Columbia, SC. If you’re ready to help individuals maintain a healthy life, then apply today!
Overall Purpose of the job:
Reviews and evaluates medical or behavioral eligibility regarding benefits. Utilizes clinical proficiency, claims knowledge/analysis, and comprehensive knowledge of healthcare continuum to assess, plan, implement, coordinate, monitor, and evaluate medical necessity, options, and services required to support members in managing their health, chronic illness, or acute illness.
Performs medical or behavioral review/authorization process.
Ensures coverage for appropriate services within benefit and medical necessity guidelines.
Utilizes allocated resources to back up review determinations.
Identifies and makes referrals to appropriate staff
Participates in data collection/input into system for clinical information flow and proper claims adjudication.
Provides active case management, assesses service needs, develops and coordinates action plans in cooperation with members, monitors services and implements plans, to include member goals.
Evaluates outcomes of plans, eligibility, level of benefits, place of service, length of stay, and medical necessity regarding requested services and benefit exceptions.
Ensures accurate documentation of clinical information to support and determine medical necessity criteria and contract benefits.
Provides telephonic support for members with chronic conditions.
RN license in the state of South Carolina
Minimum 4 years of clinical experience
Paid Time Off
Paid Federal Holidays
Medical, Dental, Vision Health Insurance Plans
401K Retirement Plan
Life and Disability Insurance