Bilingual Nurse Case Manager (Overnight 8pm to 8am)
CMN Global Inc. - Thornhill, ON

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Bilingual Nurse Case Manager (Overnight 8PM to 8AM)
(Fluent in English and Spanish)

REPORTS TO:
Assistant Operations Manager, Case Management

COMPANY BACKGROUND:
CMN Global Inc., a Europ Assistance Group company (www.europ-assistance.com), has been located in the Markham/Thornhill area for over 15 years, and serves international health insurance companies by managing medical treatment provided around the world.

CMN provides medical case management, claims processing and manages its own PPO network to discount US medical claims. Providing excellent service and communication to our clients is crucial to our customers' success.

Our environment is one of innovation, patient empathy, superior customer service, collaboration, and team work. We reward strong performance, offer competitive salaries, comprehensive benefits, and excellent opportunities for professional growth and career development. Our total compensation package also includes: a Group RRSP program, Wellness Programs and free parking.

Please visit us at www.cmn-global.com to see how we help patients, reduce health costs and maintain a strong employee culture.

CMN has a need for a Bilingual Nurse Case Manager to work with our clients

RESPONSIBILITIES:

  • Plans and reports on the development and performance of case management to ensure that there is the provision of local case management, as required.
  • Maintains all records related to case management activity, financial processes, strategic plans and activities as it relates to the day to day operations.
  • Coordinates patient care and medical treatment by directing patients to appropriate network facilities.
  • Provides medial management oversight to non-Nurse Case Managers.
  • Reviews medical facts to determine if the treatment is medically approved per client policy and is the most cost effective while maintaining quality of care.
  • Evaluates insured eligibility status and benefits, while providing pre-certification authorization as required.
  • Sends benefit letters with network affiliation indicating the length of stay and the procedures that have been approved.
  • Ensures treatment plans are appropriate for patients’ medical conditions.
  • Provides clinical assessment to determine medical necessity of air ambulance transfers and coordinates transfers as required.
  • Coordinates and communicates all relevant medical/benefit information to key stakeholders including presentations at rounds when applicable.
  • Manages a case from inception through completion of treatment.
  • Operates as the liaison between the patient/family members, the client and the provider(s).
  • Maintains comprehensive and accurate case notes, cost estimates and other relevant data.
  • Identifies cases ready for closure and completes applicable procedures.
  • Responsible for rotational nurse-on-call.
  • Assesses suitability of length of stay, tests, and diagnostics as per published standards and Medical Director.
  • Presents cost effective options for treatment to both the client and the insured.
  • Ensures treatment is delivered at the appropriate level of care (outpatient vs. inpatient)
  • Identifies and coordinates arbitration opportunities to reduce costs of treatment.
  • Performs all work in a PIPEDA and HIPAA compliant manner.

QUALIFICATIONS:

  • Fluent in English and Spanish a must
  • 2+ years of nursing experience in a hospital or clinical setting.
  • Registered Nursing diploma or degree and in good standing with the College of Nurses (copy of license to be provided annually).
  • Excellent working knowledge of computer programs.
  • Superior verbal and written communication skills.

ASSETS:

  • Experience in Medical Insurance industry.
  • Experience in Travel or Major Medical industry.
  • Experience with United States Medical system.
  • Experience with non-North American medical system.
  • Previous Case Management experience.

DEADLINE FOR APPLYING
February 1st, 2013

HOW TO APPLY:
Please send a resume with cover letter indicating the job title Bilingual Nurse Case Manager in the subject line.


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