RN Case Manager

Get To Know Us!

WebTPA, a GuideWell Company, is a healthcare third-party administrator with over
30+ years of experience building unique benefit solutions and managing
customized health plans.

What is your impact?

The RN Case Manager primary responsibility is to create, implement, and monitor
treatment plans to assist patients/members in meeting their healthcare goals.
You would use knowledge of healthcare and social services to assess needs and
provide interdisciplinary care options in treatment planning for the member.
This would include understanding the member's healthcare benefits and healthcare
best practices needed for effective treatment planning.

What Will You Be Doing

* Case Management process includes assessing the member’s health status and
care coordination needs. Can include inpatient review and discharge planning,
as well as possible outpatient management. 
* Contact with patient, family, physicians, additional health care providers,
and community resources. Contact with provider business offices and with the
employer/client may also be required. 
* Identification of alternative treatment plans, which would have to be
approved by all parties. These alternative care plans will be based on
quality care within cost containment guidelines, allowing available claims
dollars to be used in the most judicious manner possible. 
* Assessment of the clinical status and resultant sequela to coordinate the
most appropriate service to meet the individual’s health care needs. The Case
Manager will then monitor the health status and the impact of the treatment
plan for each client. The Case Manager will be responsible for altering the
care plan as deemed appropriate by the dynamic, ever-changing client needs. 
* Identification of services, resources, providers, and facilities that could
best serve members in a timely and cost-effective manner, to promote optimum
value for the client and reimbursement source. 
* Development and implementation of Case Management goals, both short and long
term, with documented care plans. 
* Utilize technology/resources to evaluate the cost-effectiveness of the
elected treatment plan, pre-implementation and post-implementation. This
outcome measurement will be used in determining the effective results and in
establishing future patient-centered care plans. 
* Accurate and timely reporting as deemed appropriate by each client member. 
* Medical record review to determine medical necessity of requested services. 
* Interpreting individual health plans and authorizing/coordinating care in
accordance with plan provisions. 

What You Must Have

* 5+ years related work experience with a professional background in clinical
nursing and patient assessment. 
* Related Bachelor’s degree or additional related equivalent work experience 
* Graduate of an accredited school of nursing 
* RN - Registered Nurse - State Licensure 
* Compact State Licensure in good standing.
* Knowledgeable in medical terminology, reasonable and necessary treatment
plans, delivery quality health care services and cost containment practices.
* Ability to collaborate with cross-operational areas within the organization.

What We Prefer

* (CCM) Certified Case Manager
* Prior experience in utilization management or case management preferred,
preferably within the managed care environment
* Intensive care or higher-acuity patient experience preferred. 
* Knowledge of managed care in a self-funded employer population is preferred. 
* Ability to identify problems such as underutilization or overutilization of
services 
* Ability to promote and maintain quality care through analysis

What We Can Offer YOU!

To support your wellbeing, comprehensive benefits are offered. As a WebTPA
employee, you will have access to:

* Medical, dental, vision, life and global travel health insurance
* Income protection benefits: life insurance, Short- and long-term disability
programs
* Leave programs to support personal circumstances
* Retirement Savings Plan includes employer contribution and employer match
* Paid time off, volunteer time off, and 11 holidays
* Additional voluntary benefits available and a comprehensive wellness program

Employee benefits are designed to align with federal and state employment laws.
Benefits may vary based on the state in which work is performed. Benefits for
interns and part-time employees may differ.

General Physical Demands

Sedentary work: Exerting up to 10 pounds of force occasionally to move objects.
Jobs are sedentary if traversing activities are required only occasionally. 

We are an Equal Employment Opportunity employer committed to cultivating a work
experience where everyone feels like they belong and can perform at their best
in pursuit of our mission. All qualified applicants will receive consideration
for employment.