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Company: HealthSmart
Location: Charleston
Posted on: May 16, 2019

Job Description:

The Case Manager is responsible for recommending process and policies to improve quality of patient services and increase revenue. Analyze information gathered by investigation, report findings and recommendations. Interview or correspond with physicians to correct errors or omissions and to investigate questionable claims. Compile, audit and analyze patient records to document condition and treatment and to provide data for cost control and care improvement efforts. Requires Registered Nurse (RN).

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Identify individuals who may benefit from case management services.
Assess clincal status and treatment needs, monitoring condition and progress.
Develop and implement a case action plan based upon needs assessment.
Provide education to patients and families in an advocate role.
Collaborate with care providers in an ongoing treatment plan and track outcomes.
Evaluation and documentation of case management impact and revision of plans to increase effectiveness.
Skilled negotiation and management of financial aspects of cases to include cost benefit analysis, claim re-pricing, development of potential savings and forecasting future medical costs.
Maintain clinical knowledge base.

HealthSmart is an equal opportunity employer and gives consideration for employment to qualified applicants without regard to race, color, religion, sex, national origin, disability or protected veteran status. If you'd like more information about your EEO rights as an applicant under the law, please visit :
EOE Minorities/Females/Disability/Veterans; VEVRAA Federal Contractor
If you need reasonable accommodation to complete the on-line application, please contact the Human Resources Department at

Keywords: HealthSmart, Charleston , CASE MANAGER, Executive , Charleston, West Virginia

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