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CategoryHealthcare
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No of Jobs1
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Apply Before12/08/2025
Description
Medical Case Manager
Generali Global Assistance - Pembroke Pines, FL
Job Title: Medical Case Manager
Position: Licensed Practical Nurse or Registered Nurse
Job Type: Full Time
Pay:
Shift: Monday-Friday mid-shift (approximately 10:00am - 6:30pm), with a two-weekend per month commitment (weekend schedule approximately 8:00am - 4:30pm)
Work Type: Hybrid
Location
Address:
City: Pembroke Pines
State: FL
ZIP Code:
Job Responsibilities
- Perform Case Management duties according to company policy and procedure.
- Collect client data and conduct emergent and non-emergent clinical assessments.
- Assist in the referral of patients to the most appropriate provider specialty/facility within the network.
- Review hospital admissions for medical necessity and assign Length of Stay (LOS) in accordance with established criteria.
- Send out appropriate communication to providers, facilities, and/or clients.
- Refer cases that do not fall within pre-established criteria to the Supervisor for further evaluation.
- Assist with the coordination of repatriation/evacuation within all phases according to client procedures and internal instructions.
- Report any change in insured's condition immediately to adjust plans.
- Enter and maintain all applicable information related to a case in GGA’s operating software.
- Attend and participate in all departmental meetings as scheduled.
- Coordinate data collection and reporting for meetings as needed.
- Evaluate and review treatment plans for consistency of care.
- Develop realistic treatment plans with provider recommendations to meet clients' needs.
- Perform written and oral communication with staff to provide case information and recommendations.
- Evaluate and determine the availability of resources in conjunction with policy limits and coverage.
- Implement cost management and deliver effective treatment plans.
- Maintain current knowledge about medical-surgical cases and continued care needs.
- Expand knowledge base and become familiar with ICD-10 for cost containment efforts.
- Report concerns and quality assurance issues to the correct Department Head.
- Follow up with corrective actions on recommendations made.
- Update the 'Tracker' system and ensure timely follow-up on each monitored case.
- Participate in issuing non-conformance and corrective actions as per ISO policy.
- Function as a clinical resource to non-clinical staff.
Required Skills
Core Skills
- Strong organizational and time management skills.
- Excellent verbal and written communication skills.
- Effective decision-making and problem-solving skills.
- Ability to work independently and in a group setting.
- Ability to interact effectively with physicians, providers, and clients.
- Knowledge of global health standards and clinical guidelines.
Preferred Skills
- Bilingual (any language)
- Basic to moderate computer literacy
- Basic to moderate typing competency
Requirements
Experience: At least five years experience in Managed Care or related acute care areas.
Education: High School Diploma or Equivalent (GED) required. Licensed health professionals: LPN or RN.
License & Certification:
- Active license in the state of Florida
- Completion of CEUs as mandated by the Board of Nursing in Florida
Schedule:
- Flexible hours with Monday-Friday mid-shift commitment
- Two-weekend per month commitment
COVID-19 Requirements: Not Specified
Benefits
- Diverse and inclusive professional work environment
- Flexible work schedules
- Company match on 401(k)
- Competitive Paid Time Off policy
- Generous employer contribution for health, dental, and vision insurance
- Company-paid short term and long term disability insurance
- Paid maternity and paternity leave
- Tuition reimbursement
- Company-paid life insurance
- Employee Assistance program
- Wellness programs
- Fun employee and company events
- Discounts on travel insurance
Supplemental Pay
- Not specified
Special Notes
- Generali Global Assistance is committed to equal employment opportunity and promotes a diverse and inclusive workplace.
Facility Details
Name: Generali Global Assistance
Description: Part of the Europ Assistance Group; offers travel insurance, assistance, and various related services.
Specialties:
- Travel insurance
- Travel assistance
- Identity and cyber protection
- Medical cost containment
Mission: Not Specified
Job Info
Discipline:
Department:
Status:
Sourcing
Duration:
Experience:
Career Level:
No of Jobs:
1
Apply Before:
12/08/2025
Posted:
09/08/2025
