Healthcare Management Administrators Looking for Remote Case Manager II at Bellevue, WA Full Time

For over 30 years, HMA has been the premier third-party health plan administrator in the PNW. We relentlessly deliver on our promise to provide employers with customized health insurance plans, for their Staff, that offer high-quality healthcare, at a reasonable cost, with first-rate customer service support.

In 2021, HMA was chosen as a Washington’s Best Workplaces by our Staff and PSBJ™. Our vision, ‘Proving What’s Possible in Healthcare™,’ and our values, People First!, Be Extraordinary, Work Courageously, Own It, and Win Together, shape our culture, influence our decisions, and drive our results.

What we are looking for: We are looking to hire people that care deeply about others, thrive in evolving environments, gain satisfaction from being part of a team and helping others succeed, are motivated by tackling complex challenges, are courageous enough to share ideas, are action-oriented, are resilient, and are results-driven.

What you can expect: You can expect an inclusive, flexible, and fun culture, comprehensive salary, benefits, and time off packages with plenty of personal development and growth opportunities. If you are looking for meaningful work, a clear purpose, high standards, work/life balance, and the ability to contribute to something important, find out more about us at: https://www.accesshma.com/

How YOU will make a Difference:

The Case Manager provides holistic primary Care Management for all client groups including Medical and Managed Behavioral Health services, monitoring of member utilization and claim patterns and ongoing case management for complex care.

Case Managers collaborate with external entities such as Brokers, Group Contacts, and Stop Loss supports to provide updated information on case specifics within HIPAA regulations.

What YOU will do:

The Case Manager Nurse demonstrates skill in core nursing processing including assessment, planning, implementation, coordination, monitoring and evaluation of proposed treatment plans. Case Managers also provide ongoing review management of treatment progress as needed to provide personalized support and care coordination for complex, catastrophic or ongoing chronic medical conditions. The Case Manager evaluates services requested to meet an individual’s health care needs, with the goal to provide personalized management to promote and ensure continuity of care coordination. This includes treatment plan oversight to maximize health and function while promoting quality, cost-effective outcomes.

The Case Manager will also perform Utilization Management and apply first the terms of the SPD (Summary Plan Description), considering any benefit limitations/exclusions and PPO status of requesting provider/facility. Reviews are conducted using approved criteria for appropriateness of services, setting/level of care and length of stay. If the request or services meet the SPD language and supporting criteria, letters of authorization are sent to the member, provider and facility. If services do not meet SPD language or supporting criteria, a secondary review is facilitated by a Board Certified Medical Director. If any request is denied, a denial notification is sent within 24 hours with rationale and appeal information provided. The denial letter is sent to member, provider, and facility.

Knowledge, Experience, and Key Attributes needed for Success:

• Current Baccalaureate prepared (Preferred) in Nursing or Community/Public Health
• Active Certification or RN clinical license, as applicable to the degree
• Strong experience in clinical practice with diverse diagnoses
• Strong leadership, problem solving and critical thinking skills
• 5+ years of clinical nursing experience, including leadership activities
• Extensive knowledge of Case Management and Utilization Review processes
• Continuous Quality improvement (CQI) or other experience in clinical process improvement
• Excellent, client-facing verbal and written communication skills
• Behavioral health experience preferred
• Proficiency with Microsoft Office applications (Outlook, Word, DOSS)
• Ability to be self-motivated and self-directed
• Enjoys the pace and rhythm of a deadline-oriented environment with strong prioritization skill sets

How we Support your Work, Life, and Wellness Goals

We offer a comprehensive total rewards package including: competitive pay; annual incentive; medical, dental, and vision insurance; 401K retirement plan with match; generous PTO and holidays; an onsite gym facility; a gym subsidy; Life, AD&D, Short-Term and Long-Term Disability Insurances; an Employee Assistance Plan; free parking and easy freeway access to I-405 and I-520; a well-stocked kitchen on-site with subsidized snacks and refreshments; year-round wellness activities; the ability to earn a $500 wellness incentive; monthly events; paid volunteer hours and more!

HMA requires a background screen prior to employment.

Protected Health Information (PHI) Access Healthcare Management Administrators (HMA) employees may encounter protected health information (PHI) in the regular course of their work. All PHI shall be used and disclosed on a need-to-know-basis and according to HMA’s standard policies and procedures.

HMA is an Equal Opportunity Employer