Registered Nurse / RN - Case Manager (10030)
Registered Nurse / RN | Columbia, SC | Contract
InGenesis is currently seeking a Registered Nurse / RN - Case Manager to work remotely with our client located in Columbia, SC. In this role, you will be responsible in reviewing and evaluating medical or behavioral eligibility regarding benefits, utilizing clinical proficiency, claims knowledge/analysis, and comprehensive knowledge of healthcare continuum.
This is a REMOTE opportunity! Apply today and we’ll reach out to answer any questions you may have.
- Perform medical or behavioral review/authorization process.
- 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.
- Ensure coverage for appropriate services within benefit and medical necessity guidelines.
- Utilize allocated resources to back up review determinations.
- Identify and makes referrals to appropriate staff.
- Participate in data collection/input into system for clinical information flow and proper claims adjudication.
- Provide active case management, assesses service needs, develops and coordinates action plans in cooperation with members, monitors services and implements plans, to include member goals.
- Evaluate outcomes of plans, eligibility, level of benefits, place of service, length of stay, and medical necessity regarding requested services and benefit exceptions.
- Ensure accurate documentation of clinical information to support and determine medical necessity criteria and contract benefits.
- Provide telephonic support for members with chronic conditions.
- Perform other duties as assigned.
- Associate degree in Nursing
- 3+ years of clinical experience
- Active and unrestricted RN license in the state of SC
InGenesis is one of the largest staffing firms in the industry and is among the largest diversity-owned healthcare staffing firms in North America. InGenesis is dedicated to placing people in positions that preserve life, improve lives, and inspire others. This does not happen without passionate people: skilled colleagues who are motivated to create innovative solutions and deliver superior service to our clients. InGenesis counts almost half of the Fortune 500 in our nearly 300 clients, including clients in the healthcare, life sciences, higher education and pharma industries.
EEO Statement on Job Postings:
InGenesis is proud to be an affirmative action employer and is committed to providing equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender identity, or Veteran status. If you have a disability or special need that requires accommodation in the hiring process, please let us know by visiting our website at https://www.ingenesis.com/careers/site-accommodations.