Bilingual Night Nurse Case Manager (French or Spanish) Job

Job Code: #739
Title: Bilingual Night Nurse Case Manager (French or Spanish)
Job Location: Thornhill ON

Job Description:

Salary: $58,000 - $65,000 + Bonus

Does it appeal to you to work full time for a rapidly growing Canadian company that is on the leading edge of the managed care industry in North America? Are you interested in applying your medical background in an office environment assisting in the management of health care for individuals?

Our client, is looking for a Night Nurse Case Manager – Bilingual (French & English) OR Bilingual (Spanish & English) to provide additional in-office and remote coverage in conjunction with their Case Management team.

Job Summary:

The Night Nurse Case Manager assesses medical necessity, ensuring proper medical management of catastrophic cases, and assessing clinicals and required actions in medical emergencies.

ACCOUNTABILITY OBJECTIVE:
- Medically manage a patient’s care within given guidelines.
- Provide caring and professional support to patients and their families.
- Plan and report on the development and performance of case management to ensure that there is the provision of local case management.
- Maintain all records related to case management activity, financial processes, strategic plans and activities as it relates to the day to day operations.
- Identify and pursue any opportunity for strategic development.

SCOPE:
- Communicate professionally with patients, their families, clients and health care providers.
- Strictly adhere to confidentiality principles and requirements.
- Communicate with all company employees, including the Claims and Repricing team, as well as the Medical Directors in a high volume, fast paced environment.
- Build alliances with all company stakeholders.

Responsibilities
/EFFORTS:
- Coordinate patient care and medical treatment by steering patients to appropriate network facilities where appropriate.
- Provide medial management oversight to non-Nurse Case Managers.
- Interact with other Case Management and Claims staff to ensure excellent service.
- Review medical facts to determine if the treatment is emergent vs. non-emergent care, fitness to travel, and travel recommendations.
- Maintain a professional yet warm demeanor when in contact with the insured/provider/client.
- Handle pre-certification of applicable cases to providers.
- Individually negotiate claims settlement when indicated by the Case Management manual or when there is not a network discount available. Document any negotiations on the patient’s file.
- Send benefit letters with network affiliation indicating the length of stay and the procedures that have been approved where required.
- Ensure care/treatment plans are appropriate for patients’ medical conditions.
- Ensure coordination and communication of all relevant medical and benefit information is relayed quickly to key stakeholders (insurance companies, patients and families, medical providers).
- Provide precise detailed reports to company clients.
- Manage a case from inception through to the final billing of claims.
- Liaise with the patient, the insurance company and the hospital with regard to the patient’s care.
- Ensure case notes and case data is comprehensive and accurate to allow client an accurate real-time picture of each and every case.
- Deal with complaints promptly following appropriate departmental protocols. Discuss with Supervisor and Case Management Leadership when appropriate.
- Forward medical notes and closing summary documentation to clients when a patient’s case is closed where required.
- Adhere to all policies and procedures as outlined in the Employee Handbook and client specific protocols.
- Perform all work in a PIPEDA and HIPAA compliant manner.
- Work in compliance with the Occupational Health and Safety Act and related legislation.
- Other related duties as assigned.

MINIMUM KNOWLEDGE/ PREREQUISITES:
- Registered Nursing degree and in good standing with the College of Nurses (copy of license to be provided annually).
- 2 + years nursing experience in a hospital or clinical setting.
- Excellent working knowledge of computer programs and office equipment.
- Exemplary verbal and written customer service skills.

PREFERRED KNOWLEDGE:
- Previous Case Management experience.
- Ability to speak multiple languages – primarily French and/or Spanish.

Please Note: You will be working three twelve-hour shifts (8am-8pm) per week (36 hrs./wk.)

FULL benefits include: Life Insurance, Employee Assistance Program, RSP Plan + Discounts for gym membership and CAA + Bonus.

If you want to be part of an international success story, and you are able to make a difference, than please send us your resume immediately!

J2W: OTHER

Job Segments: Bilingual, Case Manager, Claims, Healthcare, Insurance, Management, Manager, Night, Nursing, Operations, Patient Care