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Episodic Care Manager
3 months ago
HI ,
This is Gayatri, senior recruiter at Experis IT Manpower Group. Our client, the health care industry, is seeking an episodic care manager to join their team. The ideal candidate will have prior authorization and critical care , RN (multi state) , which will align successfully with the organization.
Job Title: Episodic Care Manager
Location: REMOTE
Pay Range: $35-$40/hr. on w2
What’s the job?
Prior authorization and Critical care experience
• Must have and maintain a valid and applicable clinical license (NC or compact multi-state licensure) to perform described job duties.
PPA outpatients procedures.
Clinical Evaluation and Review
• Receive assigned cases for varied member services (i.e. inpatient, outpatient, DME)
• Review and evaluate cases for medical necessity against medical policy, benefits, and/or care guidelines and regulations.
• Complete work in accordance with timeliness, production, clinical quality/accuracy and compliance standards
• Provide notifications to member and/or providers according to regulatory requirements.
• Assess appropriateness for secondary case review by the Medical Director (MD) for denials and coordinate as needed.
• May coordinate peer-to-peer review upon provider request when members’ health conditions do not meet guidelines
Collaboration and Documentation
• Communicate and collaborate effectively with internal and external clinical and non-clinical staff (including MDs) to coordinate work
• Appropriately and fully document outcome of reviews and demonstrate the ability to interpret and analyze clinical information
• Utilize detailed clinical knowledge to summarize clinical review against the criteria and guidelines to provide necessary information for MDs.
Hiring Requirements
• RN with 3 years of clinical experience, LPN with 5 years of clinical experience, LCSW with 3 years of clinical experience, LPC with 3 years of experience; or other applicable Behavioral Health clinical licenses with 3 years of experience.
• Prior authorization and critical care requires .
• Must have and maintain a valid and applicable clinical license (NC or compact multi-state licensure) to perform described job duties.
If this is a role that interests you and you’d like to learn more, click apply now and a recruiter will be in touch with you to discuss this great opportunity. We look forward to speaking with you
About ManpowerGroup, Parent Company of: Manpower, Experis, Talent Solutions, and Jefferson Wells
ManpowerGroup® (NYSE: MAN), the leading global workforce solutions company, helps organizations transform in a fast-changing world of work by sourcing, assessing, developing, and managing the talent that enables them to win. We develop innovative solutions for hundreds of thousands of organizations every year, providing them with skilled talent while finding meaningful, sustainable employment for millions of people across a wide range of industries and skills. Our expert family of brands – Manpower, Experis, Talent Solutions, and Jefferson Wells – creates substantial value for candidates and clients across more than 75 countries and territories and has done so for over 70 years. We are recognized consistently for our diversity - as a best place to work for Women, Inclusion, Equality and Disability and in 2022 ManpowerGroup was named one of the World's Most Ethical Companies for the 13th year - all confirming our position as the brand of choice for in-demand talent.
ManpowerGroup is committed to providing equal employment opportunities in a professional, high quality work environment. It is the policy of ManpowerGroup and all of its subsidiaries to recruit, train, promote, transfer, pay and take all employment actions without regard to an employee's race, color, national origin, ancestry, sex, sexual orientation, gender identity, genetic information, religion, age, disability, protected veteran status, or any other basis protected by applicable law.
