Nurse Case Manager

About Global Medical Management At Generali Global Assistance (GGA) every day is an opportunity to help people explore the world with confidence. We are more than a protection business – we are a partner for adventure and peace of mind, supporting travelers through emergencies, trip disruptions, and medical claims, turning challenges into stories of resilience. Internal Development Programs Diversity, Equity, and Inclusion (DEI) Committee Career pathing and Individual Development Plans Internal training and internship opportunities Women in Business Mentorship Program Employee awards and recognition Education and professional development assistance program Benefits Generous employer contribution for health, dental, and vision insurance Paid maternity and paternity leave Scholarship program for employee dependents Company match on 401(k) Employee Assistance Program (EAP) Company‑paid short‑term and long‑term disability insurance Voluntary pet insurance Voluntary legal benefit Discounts on travel insurance Time‑off policies that include vacation days, sick days, personal days, holidays, and volunteer days (VTO) Your Role on the Expedition The Medical Case Manager is a licensed practical nurse or registered nurse who assumes responsibility for securing and reviewing clinical data to approve admissions, procedures, and services that meet clinical review criteria. The role requires coordination and delegation of care among all providers, ensures procedures are not duplicated, and that services align with industry standards of care. All documentation is performed in accordance with HIPAA and/or GDPR compliance. Responsibilities Collect client data and conduct emergent and non‑emergent clinical assessments. Assist in the referral of patients to the most appropriate provider specialty or facility within the network. Monitor and screen pre‑authorization requests for second medical opinion referrals and/or diagnostic testing. Review hospital admissions for medical necessity and assign length of stay according to established criteria; communicate outcomes to providers, facilities, and clients. Refer cases that fall outside established criteria to the supervisor for further evaluation, admission approval, or referral to a medical director or peer reviewer. Assist with the issuance of notices when an admission, procedure, or service is denied, ensuring timely distribution to all parties. Perform discharge planning duties to contain length of stay and confirm that the insured is receiving services within the 6 Rights framework (Care, Place, Time, Provider, Price, Outcome). Coordinate repatriation or evacuation within all phases, following client procedures and internal SOPs; report any change in the insured’s condition immediately. Enter and maintain all case information in GMMI operating software. Evaluate treatment plans for consistency of care, develop realistic plans aligned with provider recommendations, and ensure cost effectiveness. Assess resource availability relative to policy limits and coverage; implement cost management strategies. Maintain up‑to‑date knowledge of medical‑surgical cases, utilization management, discharge planning, and ongoing care needs, including ICD‑10 application for cost containment. Update the “Tracker” system and follow up on each monitored case in a timely manner. Serve as a clinical resource to non‑clinical staff. Qualifications High School Diploma or Equivalent (GED). Licensed health professional: LPN or RN with an active state of Florida license. At least two years of experience in managed care or related acute care settings (medical/surgical, OB/GYN, pediatrics, cardiology, neurology, nephrology, orthopedics, transplant, or CCU/ICU). Ability to maintain confidentiality of client/member information. Strong organizational and time‑management skills with emphasis on multitasking and prioritization. Excellent verbal and written communication skills. Effectiveness in interacting with physicians, providers, internal staff, and insureds. Preferred Qualifications Bilingual proficiency in any language. Location & Work Arrangement This hybrid role is based in Pembroke Pines, FL. Employees will work onsite 2‑3 days a week and from home 2‑3 days a week. Equal Employment Opportunity The Company is committed to providing equal employment opportunity in all employment programs and decisions. Discrimination in employment on the basis of any classification protected under federal, state, or local law is a violation of our policy. Equal employment opportunity is provided to all employees and applicants for employment without regard to age, race, color, religion, creed, sex, gender identity, gender expression, transgender status, pregnancy, childbirth, medical conditions related to pregnancy or childbirth, sexual orientation, national origin, ancestry, ethnicity, citizenship, genetic information, marital status, military status, HIV/AIDS status, mental or physical disability, use of a guide or support animal, or any other legally protected basis under applicable law. This policy applies to all terms and conditions of employment, including recruitment, hiring, classification, placement, promotion, termination, reductions in force, recall, transfer, leaves of absence, compensation, and training. Employees with questions about equal employment opportunities are encouraged to bring concerns to Human Resources. Retaliation against individuals who raise such issues is prohibited. All employees must comply with the Company’s Equal Opportunity Policy, and violations may result in disciplinary action, up to and including termination. #J-18808-Ljbffr