What are the responsibilities and job description for the Nurse Case Manager position at battleface?
about us: battleface is building a humanity-focused travel insurance company to bring people and the world together. For far too long travel insurance has focused on the company, not the customer. We’re changing that by connecting travelers to customized insurance solutions that deliver the right insurance at the right price—right where and when they need it.
At battleface, our focus is always on the customer’s journey, both literally and figuratively, and the crossroads of that journey lives in our portfolio of products. We use that portfolio to assess risk, provide emergency medical assistance, pay claims, and connect to travelers.
We’re looking for a Nurse Case Manager who can help us shape the future of emergency travel and medical assistance.
about you: You are a quick learner who loves a new challenge, always interested exploring how the latest technology and incredible customer service can help solve problems. The perfect candidate is someone who can anticipate future customer needs, wants to help us define what those needs are, and help us address them. This includes a passion for helping others, arranging for best possible medical care and coordinate for flawless customer care during medical emergencies. Titles define individual roles, but at battleface, it’s working off-CV and with the team that is essential for contributing to our rapid growth.
We're looking for a Nurse Case Manager who will:
- Coordinate care directly with patients and their families via telephone & email
- Work in conjunction with our operations team and Medical Advisors to effectively provide assistance to patients requiring medical attention
- Ensure medically appropriate, high-quality, cost-effective care through assessing the medical necessity of inpatient admissions, outpatient services, out of network services, and suitability of treatment setting and level of care
- Partner with physician clinical reviewers and/or medical advisors to interpret appropriateness of care, intervention planning, and general clinical guidance
- Collaborate with providers to assess customer needs for coordination of benefits, early identification of and proactive planning for discharge
- Conduct clinical assessments to develop goals addressing individual needs to develop a care plan; implement and coordinate a care plan
- Monitor and evaluate effectiveness of the care management plan and modifies as necessary
- Assist with development of utilization/care management policies and procedures
- Participate in or lead intradepartmental teams, projects, and improvement initiatives
- Work with cost containment providers when directing billing
- Set up of medical appointments
- Facilitate case logistics when needed, including transportation, coordination of benefits with the claims team and providing updates
essentials:
- Minimum of 3 years of acute care clinical experience, condition specific clinical experience, home health/discharge planning experience
- Minimum of 1 year in a similar role or equivalent experience; or any combination of education and experience, which would provide an equivalent background
- Current, unrestricted RN license in applicable state(s) is required
- AS or BS in nursing preferred
- Certification as a Case Manager is preferred
- Participation in the American Association of Managed Care Nurses preferred
- Prior managed care experience preferred
- Knowledge of medical management process and ability to interpret and apply member contracts, member benefits, and managed care products strongly preferred
even better:
- Startup experience
- Insurance experience
- Worldwide travel