Shire Jobs

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.

JOB DETAILS

• RN License -- Must have an active RN license in good standing in Indiana.
• Location:Hybrid orRemoteworking options.
• Corporate office is in Indianapolis, IN.
• Relocation Expenses Reimbursed: No
• Qualified candidates must be legally authorized to be employed in the United States. IMG will not beproviding sponsorship for employment visa status (e.g., H-1B or TN status) for this position.

JOB SUMMARY The Case Manager will evaluate medical necessity, appropriateness, and efficiency of the use of health care services, procedures, and facilities for utilization review and /or /evacuation/repatriation. Work as a liaison between the Insured, the insurance carrier and the Insureds healthcare team to meet the requirements of the Insureds policy in the United States and abroad.

PERKS

• Comprehensive benefits package including Medical/RX/Dental/Vision insurance
• 401k Plan with company match
• Paid Time Off and Company Paid Holidays
• Free employee parking
• On site fitness center
• Casual dress environment
• Tuition reimbursement plan

DUTIES AND RESPONSIBILITIES

• Perform Certifications, Concurrent Reviews, Retrospective Reviews, and Medical Evacuations/Repatriations including inpatient and outpatient management of assistance cases.
• Knowledge of the Non-certification process and Appeals process including logs and time frames.
• Participate in the on call rotation schedule.
• The provision of telephone and email based pre travel advice
• 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 case management systems and document
• 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 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.

QUALIFICATIONS

• Current and active Nursing license - Registered Nurse
• Minimum two years acute hospital-based experience providing direct patient care
• Good computer skills including familiarity with the Internet, Word and Excel.

PREFERRED SKILLS

• B.S.N. Preferred
• Minimum two years utilization review with a managed care or insurance company
• 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

PROFESSIONAL COMPETENCIES

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