Full-Time Nurse Case Manager (RN)

We are excited to welcome a Full-Time Nurse Case Manager (RN) position to our growing team! AHDI is the American Health Data Institute, part of the Key Family of Companies. Our organization is consistently named a Top Workplace by our employees year after year, and we are excited to speak to qualified candidates about this new work from home opportunity!

We believe in delivering a Wow level of service to our valued clients and living up to our mission of improving people's health through high quality, cost-effective care. Strong core values, supportive work relationships, high quality training and personal development are part of our DNA and we are looking for the right individual to join us!

If you are passionate about delivering high-quality service and would like to be part of our supportive family culture - we want to hear from you. The Full-Time Nurse Case Manager (RN) position includes a comprehensive benefit package, full training program and competitive salary!

Full-Time Nurse Case Manager (RN) Overview: The Nurse Case Manager provides excellence in Case Management for AHDI and Key Family clients to ensure patients are receiving the highest quality care, at the most appropriate level of care.

Essential Duties and Responsibilities of the Full-Time Nurse Case Manager (RN):

• Communicates with physicians and health care providers/suppliers to gather information, and when appropriate, to discuss the Alternative Treatment Plan (ATP) possibilities. When appropriate, initiates patient/family contact.
• Communicates with providers and medical services/equipment to facilitate effective referrals and ATP development.
• Arranges and reviews for patient hospital discharge needs, including home health care, skilled nursing facility, and /or Durable Medical Equipment (DME), when appropriate.
• Reviews and follows medical necessity for patients admitted to home health care, skilled nursing facility or residential facility.
• Submits various case management reports at appropriate times to keep appropriate parties informed of case status. Runs and/or reviews UR related reports for accuracy as needed.
• Reviews weekly inpatient admissions for potential case management needs and for reporting purposes to designated accounts and reinsurers.
• Reviews monthly high dollar claims reports for potential case management needs.
• Verifies and coordinates appropriate utilization of contract benefits and networks for providers, accounts and/or members.
• Reviews specialty pharmacy claims for correct billing and possible case management.

Competencies, Knowledge, Skills and Abilities:

• Registered Nurse, with a current, unrestricted license
• Strong clinical background - preferably 3-5 years of experience in acute care, skilled or rehabilitative clinical settings.
• Polished communication skills both oral & written. Speaks clearly and persuasively in positive or negative situations. Writes clearly and informatively.
• Good data entry and basic computer skills, proficient in Microsoft Word, Excel & Outlook, with the ability to quickly learn new applications.
• Able to work independently and as a part of a team, functioning as a Case Manager.
• Ability to work in a proficient and timely manner to meet service expectations.
• Professional business demeanor.
• Strong work ethic.
• Ability to maintain confidentiality.

A background in Case Management and/or Utilization Review is required.

More about AHDI and the Key Family:

Founded in 1979 as a full-service group benefits administration firm specializing in self-funded medical plans, the Key Family has grown to become one of the country's largest independently owned third party administrators, supporting a wide variety of group benefit plans.

Learn more about the Key Family and AHDI here: https://ahdi.com/

If you are unable to complete an application for the Full-Time Nurse Case Manager (RN) position due to a disability, contact Human Resources by calling 800-560-3539 to ask for an accommodation or an alternative application process.

All qualified applicants for the Full-Time Nurse Case Manager (RN) position will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.