90 Degree Benefits is seeking a full-time RN Case Manager to join our team. The ideal candidate will have responsibilities in the following areas: utilization review and processing of authorization requests, disease management, wellness mentoring, risk assessment, and Stop Loss (SL) reporting, all performed according to policies and procedures of 90 Degree Benefits.
This position will evaluate and manage catastrophic episodes of illness for 90 Degree Benefits’ client members and ensure that the insured is receiving the best medical care in the most cost-effective manner.
Essential Duties and Responsibilities:
Acquire member information and maintain records and proficiency in the use of the clinical and claims software programs to include Deerwalk (Plan Analytics, Care Manager and Health Portal) and claims systems.
Review policyholder data to identify claimants with catastrophic care needs, and assess medical and claims information available to calculate potential risk and large loss claims, using the Utilization Review process, predictive modeling, Deerwalk Plan Analytics Cohorts, claims referral, pending claim reports, customer service referral, client referral, and other methods as indicated.
Assure high risk and potential large loss individuals are flagged in the Care Manager system for SL reporting, evaluated for SL notification/reporting and assessment of ongoing claim potential, and referred to management for review.
Provide written claimant assessments within established deadlines for Account Managers to use when meeting with Brokers to establish rates for new and renewal business.
Generate renewal reports, including the SL/Case Management Summary, Trigger Diagnosis, Precert, and Discharge reports.
Provide reports for inclusion in group’s SL renewal and/or management report packet.
Participate in meetings to provide the clinical aspect of SL renewals.
Attend the occasional health fair and/or client meeting to educate and mentor.
Maintain industry awareness of new diagnoses, treatments, costs, and industry trends.
Respond to verbal or written requests and provide clinical opinion from knowledge, experience, and research.
Assist with assessing and recommending effective claim cost containment and healthcare trends for clients for potential solution implementation or wellness mentoring.
Perform other activities and clinical functions, as requested.
Maintain licensure, certification, and continuing education as indicated for case management, utilization review, wellness, and chronic condition management programs and the professional staff.
Bachelor’s degree (or higher) in Health Care Administration, Nursing or related field from a four-year college or university or equivalent combination of experience and education.
Five or more years of management experience in utilization review/case management in the self-insured environment.
Experience with TPA, SL reinsurance contract administration, risk management and quality assessment preferred.
Case Management certification (CCM) desired. Utilization Management, Disease Management and/or Wellness Certification considered a plus.
Understanding of legal and ethical issues pertaining to confidentiality and liability associated with utilization management, case management, wellness plans, and benefit administration.
Data analytics and report preparation experience and the ability to explain findings to clients.
Excellent communication skills; ability to write procedures, reports, and correspondence and speak effectively in group presentations and training seminars.
Strong organizational skills; ability to work with multiple projects simultaneously and complete assignment within prescribed time frame.
Ability to deal with problems and apply understanding to complex administrative issues.
Additional Salary Information: Salary is determined based on skillset, education, and experience.
About Corporate Benefits Service, Inc., a 90 Degree Benefits' company
90 Degree Benefits is a health benefits company with a mission: to help employers Make the Right Turn™ for their business through strategically crafted benefit offerings. With every business being unique, no path to success looks the same. 90 Degree Benefits designs health plans and administers benefits that meet each employer’s unique health and operational needs, both now and for the road ahead.
We believe the right health plan does more than just provide benefits. It provides peace of mind for both employees and employers and contributes to the overall success of the organization. The 90 Degree Benefits vision is to help each employer Make the Right Turn™ for their business.
What Information Do We Collect?
When you visit our website you may provide us with two types of information: personal information you knowingly choose to disclose that is collected on an individual basis and website use information collected on an aggregate basis as you and others browse our website.
Personal Information You Choose to Provide
We may request that you voluntarily supply us with personal information, including your email address, postal address, home or work telephone number and other personal information for such purposes as correspondence, placing an order, requesting an estimate, or participating in online surveys.
If you choose to correspond with us through email, we may retain the content of your email messages together with your email address and our responses. We provide the same protections for these electronic communications that we employ in the maintenance of information received by mail and telephone.
Website Use Information
Similar to other websites, our site may utilize a standard technology called "cookies" (see explanation below, "What Are Cookies?") and web server logs to collect information about how our website is used. Information gathered through cookies and server logs may include the date and time of visits, the pages viewed, time spent at our website, and the sites visited just before and just after ours. This information is collected on an aggregate basis. None of this information is associated with you as an individual.
How Do We Use the Information That You Provide to Us?
Broadly speaking, we use personal information for purposes of administering our business activities, providing service and support and making available other products and services to our customers and prospective customers. Occasionally, we may also use the information we collect to notify you about important changes to our website, new services and special offers we think you will find valuable. The lists used to send you product and service offers are developed and managed under our traditional standards designed to safeguard the security and privacy of all personal information provided by our users. You may at any time to notify us of your desire not to receive these offers.
What Are Cookies?
Cookies are a feature of web browser software that allows web servers to recognize the computer used to access a website. Cookies are small pieces of data that are stored by a user's web browser on the user's hard drive. Cookies can remember what information a user accesses on one web page to simplify subsequent interactions with that website by the same user or to use the information to streamline the user's transactions on related web pages. This makes it easier for a user to move from web page to web page and to complete commercial transactions over the Internet. Cookies should make your online experience easier and more personalized.
How Do We Use Information Collected From Cookies?
We use website browser software tools such as cookies and web server logs to gather information about our website users' browsing activities, in order to constantly improve our website and better serve our users. This information assists us to design and arrange our web pages in the most user-friendly manner and to continually improve our website to better meet the needs of our users and prospective users.
Cookies help us collect important business and technical statistics. The information in the cookies lets us trace the paths followed by users to our website as they move from one page to another. Web server logs allow us to count how many people visit our website and evaluate our website's visitor capacity. We do not use these technologies to capture your individual email address or any personally identifying information about you.
Notice of New Services and Changes
Occasionally, we may use the information we collect to notify you about important changes to our website, new services and special offers we think you will find valuable. As a user of our website, you will be given the opportunity to notify us of your desire not to receive these offers by clicking on a response box when you receive such an offer or by sending us an email request.
How Do We Secure Information Transmissions?
When you send confidential personal information to us on our website, a secure server software which we have licensed encrypts all information you input before it is sent to us. The information is scrambled en route and decoded once it reaches our website.
Other email that you may send to us may not be secure unless we advise you that security measures will be in place prior to your transmitting the information. For that reason, we ask that you do not send confidential information such as Social Security, credit card, or account numbers to us through an unsecured email.
How Do We Protect Your Information?
Information Security -- We utilize encryption/security software to safeguard the confidentiality of personal information we collect from unauthorized access or disclosure and accidental loss, alteration or destruction.
Evaluation of Information Protection Practices -- Periodically, our operations and business practices are reviewed for compliance with organization policies and procedures governing the security, confidentiality and quality of our information.
Employee Access, Training and Expectations -- Our organization values, ethical standards, policies and practices are committed to the protection of user information. In general, our business practices limit employee access to confidential information, and limit the use and disclosure of such information to authorized persons, processes and transactions.
How Can You Access and Correct Your Information?
You may request access to all your personally identifiable information that we collect online and maintain in our database by emailing us using the contact form provided to you within the site structure of our website.
Do We Disclose Information to Outside Parties?
What About Legally Compelled Disclosure of Information?
We may disclose information when legally compelled to do so, in other words, when we, in good faith, believe that the law requires it or for the protection of our legal rights.
Permission to Use of Materials
The right to download and store or output the materials in our website is granted for the user's personal use only, and materials may not be reproduced in any edited form. Any other reproduction, transmission, performance, display or editing of these materials by any means mechanical or electronic without our express written permission is strictly prohibited. Users wishing to obtain permission to reprint or reproduce any materials appearing on this site may contact us directly.
We are grateful for your donation and support of our organization. If you have made an error in making your donation or change your mind about contributing to our organization please contact us. Refunds are returned using the original method of payment. If you made your donation by credit card, your refund will be credited to that same credit card.
Automated Recurring Donation Cancellation
Ongoing support is important to enabling projects to continue their work, so we encourage donors to continue to contribute to projects over time. But if you must cancel your recurring donation, please notify us.