Case Manager, RN

Imagine360 is an integrated health plan addressing one of the greatest challenges on behalf of self-funded employers: healthcare costs are harming the bottom line, they're increasingly unaffordable for employees, and the experience remains poor. We help businesses and their employees navigate through clutter and chaos and bring deep cost savings that protect everyone’s well-being and budgets. It’s way more than a health plan. It’s a promise. We’ve helped hundreds of self-funded clients. Our solutions are ready to be implemented. The results are proven and impactful. Imagine360’s innovative payment model includes preferential contracting with providers and health systems, and additional price protection through reference-based pricing, saving employers 15-30% on average compared to the national carriers. With more than 17 years’ experience, and 25-million-months of member data, Imagine360 offers care coordination and medical management to proactively guide members through the complexities of healthcare. We bring employers a reimagined health plan solution, created to provide the flexibility, service and support employers need to take good care of employees, their families and business. We do this through: Assistance with plan design and expert administration with integrated third-party administration Built-in price protection from the #1 reference-based pricing solution in healthcare Provider contracts with Imagine Health’s top-rated providers and health systems Comprehensive member support throughout their healthcare journey It’s more than a health plan. It’s our promise to deliver a better health plan experience.

Imagine360 is currently seeking a Case Manager RN to join the team! The RN is responsible to providing case management for individuals under the group health plans administered by Imagine360 by utilizing nursing education, clinical and professional experience. Position Location: 100% Remote

Identify, collect, process and manage data to perform the Case Management process by utilization Imagine360 approved clinical guidelines and following Medical Management Policy and Procedures Completes clinical assessments per P&P to identify and deliver indicated medical service coordination Completes medical necessity, utilization management reviews, and review of benefits as part of the pre-determination process Identify and refer cases for Physician Advisor reviews Utilize clinical knowledge, expertise and educational resources to provide verbal and/or written educational resources to members regarding diagnosis, procedures and/or treatment Assess the need for and collaborate with community resources for members in case management Perform negotiations with providers Uses assigned software accurately to document to complete and document all steps of review of medical necessity and case management process, including time slips Facilitate the Patient Satisfaction Surveys Assess for cost savings and document the cost saving in assigned software platform Appropriately refer complex cases to Manager, Case Management Attend scheduled and periodic meetings, training and other job specific events as required either by teleconference or onsite Adhere to established internal regulations regarding Department of Labor, HIPAA, ERISA and Medical Management Policy and Procedure Participate in the Quality Management Program via collecting and adhering to performance metrics per Case Management Policy