LTSS Service Care Manager

5 days ago

Orange City, United States Pyramid Consulting Full time

Immediate need for a talented LTSS Service Care Manager. This is a 09+months contract opportunity with long-term potential and is located in Orange County, FL / CA(Remote). Please review the job description below and contact me ASAP if you are interested.

Job ID: 24-50486

Pay Range: $40 - $42/hour. Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location).

Key Responsibilities:

  • Monday through Friday 8am to 5pm (PST)
  • Promote the quality and cost effectiveness of medical care by applying clinical acumen and the appropriate application of policies and guidelines to emergent/urgent and continued stay reviews.
  • Job Responsibilities: Perform review of concurrent and continued stay requests for appropriate care and setting, following guidelines and policies, and approve services or forward requests to the appropriate Physician or Medical Director for secondary review.
  • Complete medical necessity and level of care reviews for requested services using InterQual guidelines and refer to Medical Directors for review depending on case findings.
  • Collaborate with various staff within provider networks and discharge planning team electronically and telephonically to coordinate member care.
  • Conduct discharge planning. Educate providers on utilization and medical management processes.
  • Provide clinical knowledge and act as a clinical resource to non-clinical team staff.
  • Enter and maintain pertinent clinical information in various medical management systems.
  • Nurses are expected to Review an average of 20 cases/day
  • Nurses start off in our 8 week Learning Journey Program which takes them through our computer programs used to perform their job
  • After learning Journey, they are placed on a 90 day ramp up with their preceptor monitoring quality and productivity performance.
  • Any concerns from their preceptor are escalated to the Manager for review.
Key Requirements and Technology Experience:
  • Key skills; Utilization Management, Case Management, or Discharge Planning
  • Education/Experience: Graduate from an Accredited School of Nursing.
  • ASN or BSN preferred Current state's RN license. 2-4 years of experience in Utilization Management, Case Management, or Discharge Planning
  • Computer Skills- Microsoft, Teams, Zoom
  • Good communication skills for clinical rounds
  • 2-4 years of hospital, managed care, UM exp
  • Knowledge of InterQual reviews
  • Graduate from an accredited School of Nursing
  • Microsoft, basic computer knowledge with electronic medical record programs
  • California Registered Nurse
  • InterQual Interrater Reliability Testing

Our client is a leading Healthcare Industry, and we are currently interviewing to fill this and other similar contract positions. If you are interested in this position, please apply online for immediate consideration.

Pyramid Consulting, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, colour, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

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