Nurse Case Manager

At Redion, every day is an opportunity to help people explore the world with confidence. We’re not just in the business of protection—we’re in the business of adventure and peace of mind. Whether it’s a backpacker trekking through the Andes, a family cruising the Mediterranean, or a solo traveler chasing the Northern Lights, we’re there to ensure their journey is safe and supported.

From assisting with emergency medical claims to guiding customers through trip disruptions or , your work helps turn travel challenges into stories of resilience.

Our Teams Value Curiosity And Collaboration While Priding Ourselves On Fostering a Welcoming And Inclusive Atmosphere For Our Employees. Elevate Your Journey Through Our Internal Programs, Including

• Diversity, Equity, and Inclusion (DEI) Committee
• Career pathing and Individual Development Plans
• Internal training and intern opportunities
• Women in Business Mentorship Program
• Employee awards and recognition
• Education and professional development assistance program

• Generous Employer contribution for health, dental, and vision insurance
• Paid Maternity and Paternity Leave
• Scholarship Program for Employee Dependents
• Company match on 401k
• Employee Assistance Program (EAP)
• Company paid short-term and long-term disability insurance
• Company paid life insurance
• Voluntary Pet Insurance
• Voluntary Legal Benefit
• Discounts on travel insurance
• Time off policies including vacation days, sick days, personal days, holidays and volunteer days (VTO)

The Medical Case Manager is a Licensed Practical Nurse or a Registered Nurse who is accountable and capable of securing and reviewing clinical data in order to approve requests for admissions, procedures and services that meet clinical review criteria. Ensures that there is coordination and delegation of care between all providers involved. Ensure that procedures / services are not duplicated and that services being rendered fall within the industry standards of care.

The Medical Case Managers responsibilities include but are not limited to: assessment of strengths and weaknesses, implementation of a treatment plan, coordination and availability of resources, familiarity with the insured policy and its limitations and the communication and documentation with the appropriate entities that require information as per the stated policies and procedures while adhering to HIPAA and/or GDPR compliance.

The Medical Case Manager (UR/UM/CM) is NOT financially incentivized for decisions that result in under utilization, adverse determinations and / or denials.

• Collects client data and conducts emergent and non-emergent clinical assessment.
• Assists in the referral of patients to most appropriate provider specialty / facility within Network.
• Monitors and screens pre-authorization requests for second medical opinion referrals and/or diagnostic testing.
• Reviews hospital admissions for medical necessity and assigns LOS in accordance with established criteria. Sends out appropriate communication to providers, facilities and/or client.
• Refers all cases that do not fall within pre-established criteria to the Supervisor for further evaluation and determination of admission approval, procedure or services requested or refer to Medical Director or peer reviewer.
• Medical Case Managers do not issue non-certifications (denials). Once it is determined that an admission, procedure or service should be denied; assists in assuring that verbal or written denial notices are distributed out to the appropriate parties in a timely manner.
• Performs duties of the discharge planning nurse to contain LOS and assure that the insured…