Case Manager II

HMA is the premier third-party health plan administrator across the PNW and beyond. We relentlessly deliver on our promise to provide medium to large-size employers with customized health plans. We offer various high-quality, affordable healthcare plan options supported with best-in-class customer service.
We are proud to say that for four years, HMA has been 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 always searching for unique people to diversify our team. We only hire people that care deeply about others, thrive in evolving environments, gain satisfaction from being part of a team, are motivated by tackling complex challenges, are courageous enough to share ideas, action-oriented, resilient, and results-driven.
What you can expect: You can expect an inclusive, flexible, and fun culture, comprehensive salary, pay transparency, benefits, and time off package 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.
• Provide ongoing review management of treatment progress as needed to provide personalized support and care coordination for complex, catastrophic or ongoing chronic medical conditions.
• 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.
• 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.

Knowledge, Experience, and Key Attributes needed for Success:

• Current Baccalaureate prepared (Preferred) in Nursing or Community/Public Health
• 3-5+ years of clinical nursing experience
• Active Certification or RN clinical license, as applicable to the degree
• 3+ years of utilization review experience (specialty medications)
• Problem solving and critical thinking skills
• Knowledge of Case Management and Utilization Review processes
• Excellent, client-facing verbal and written communication skills
• Ability to be self-motivated and self-directed
• Enjoys the pace and rhythm of a deadline-oriented environment with strong prioritization skill sets
• Enjoys working in a collaborative environment
• Proficiency with Microsoft Office applications (Outlook, Word, DOSS)

Compensation:
The base salary range for this position in the greater Seattle area is $95,000 - $111,000 and varies dependent on geography, skills, experience, education, and other job or market-related factors. Performance-based incentive bonus(es) is available.
Disclaimer: The salary, other compensation, and benefits information are accurate as of this posting date. HMA reserves the right to modify this information at any time, subject to applicable law.
In addition, HMA provides a generous total rewards package for full-time employees that includes:

• Seventeen (IC) days paid time off (individual contributors)
• Eleven paid holidays
• Two paid personal and one paid volunteer day
• Company-subsidized medical, dental, vision, and prescription insurance
• Company-paid disability, life, and AD&D insurances
• Voluntary insurances
• HSA and FSA pre-tax programs
• 401(k)-retirement plan with company match
• Annual $500 wellness incentive and a $600 wellness reimbursement
• Remote work and continuing education reimbursements
• Discount program
• Parental leave
• Up to $1,000 annual charitable giving match

How we Support your Work, Life, and Wellness Goals
At HMA, we believe in recognizing and celebrating the achievements of our dedicated staff. We offer flexibility to work schedules that support people in all time zones across the US, ensuring a healthy work-life balance. Employees have the option to work remotely or enjoy the amenities of our renovated office located just outside Seattle with free parking, gym, and a multitude of refreshments. Our performance management program is designed to elevate career growth opportunities, fostering a collaborative work culture where every team member can thrive. We also prioritize having fun together by hosting in person events throughout the year including an annual all hands, summer picnic, trivia night, and a holiday party.
We hire people from across the US (excluding the state of Hawaii and the cities of Los Angeles and San Francisco.)
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.
For more information about HMA, visit www.accesshma.com .