Case Manager Nurse - USRN

The Case Manager Nurse will regularly liaise with multiple clinical specialties and doctors. This role also involves 
consistent interactions with insurance providers, patients and their families, legal delegates, and representatives from 
other medical care institutions. Additionally, they will often communicate with nursing staff, billing teams, medical 
social workers, and personnel from various departments.

Primary Roles Responsibilities

• Performs case management including obtaining prior authorization for drugs and procedures according to hospital policy and procedures.
• Promotes, coordinates, and takes responsibility for completion of all activities associated with case management.
• Ensure that all patient information is handled in accordance with HIPAA regulations.
• Ability to perform tasks in line with authorizations for outpatient services, denial letters, and similar activities.

Qualifications:

• Graduate of BS Nursing, USRN required.
• At least 2 years previous hospital nursing experience or Case Management experience in a clinical setting for a US-based healthcare company, required.
• Two years previous hospital nursing experience, preferred
• Excellent verbal and written communication skills; ability to communicate with attending physicians regarding clinical determinations; ability to speak clearly and concisely, conveying complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information from others.
• High level of integrity as demonstrated by appropriate treatment of confidential information, adherence to policies, procedures, rules and regulations, professional conduct in dealing with persons internal and external to the organization, and sensitivity to the populations served and the providers with which MHS works.
• Demonstrated knowledge of payers, payer systems, cost effective utilization management, insurance terminology, InterQual criteria and Milliman guidelines, preferred.
• Clinical competence in understanding hospital care and care coordination.
• Ability to apply InterQual and other applicable criteria for all applicable inpatients and outpatients on a concurrent basis.
• Ability to write appeals letter and ability to follow through for successful appeals
• Proficient computer and software skills

ADDITIONAL REQUIREMENT:

• Willing to work in Ortigas in an onsite work arrangement.
• Amenable to work in a graveyard shift schedule

About Vee Healthtek:

Vee Healthtek is a leading professional services provider and strategic partner to the nation’s top healthcare organizations. Backed by a history of innovation, Vee Healthtek is dedicated to delivering industry-best results backed by data and technology. With a comprehensive suite of end-to-end solutions, the firm delivers excellence in healthcare business process outsourcing services.