Nurse Case Manager Position Available In Chester, Pennsylvania

Nurse Case Manager Medical Fund Advisors Exton, PA 19341 We are seeking an experienced and detail-oriented registered nurse to assist beneficiaries of private medical trusts in a claims setting. In this role, your expertise will obtain telephonic medical updates on existing and new trusts to support the claims staff to make determinations on existing and future claims. This is an in-office position.

Key Responsibilities :

Evaluate and interpret medical documentation, diagnostic testing, and treatment history to determine if medical criteria for coverage by the trust are met. : Verify consistency, completeness, and identifying missing information or red flags. : Collaborate with claims department to clarify clinical findings and support determinations. : Document rationale for approval or denial recommendations in clear, concise review summaries. : Perform periodic reviews by contact with beneficiaries and/or guardians. Oversee activities of field NCMs. : Ensure reviews follow HIPAA guidelines and comply with trust standards and applicable regulations. : Participate in training and quality assurance initiatives to maintain up-to-date knowledge of trust policies and medical developments relevant to claims. Qualifications Registered Nurse (RN) license in good standing. Case Management certification desirable but not required. Minimum of 5 years of clinical experience, preferably in long term catastrophic injury/disease care management and/or case management. Strong analytical skills and attention to detail. Proficiency in interpreting complex medical records. Excellent written and verbal communication skills. Ability to work independently and manage multiple cases simultaneously. Familiarity with ICD coding and claims process a plus.

Job Type:

Part-time Expected hours: 16 – 24 per week

Benefits:

Paid time off

Schedule:

Day shift Monday to Friday No nights No weekends

Experience:

Nursing:

5 years (Preferred)

License/Certification:

Nursing License (Required) Ability to

Commute:

Exton, PA 19341 (Required) Ability to

Relocate:

Exton, PA 19341: Relocate before starting work (Required)

Work Location:

In person