Long-Term Service Care Manager
1 week ago
LTSS Service Care Manager
About Our CompanyWe are a leading healthcare consulting firm dedicated to delivering exceptional services in long-term care management.
Job SummaryWe seek a skilled LTSS Service Care Manager to join our team in Orange County, FL/CA. This is a challenging contract opportunity with long-term potential for career growth.
Key Responsibilities:- Promote high-quality and cost-effective medical care by applying clinical expertise and guidelines to reviews of emergent, urgent, and continued stays.
- Conduct reviews of concurrent and continued stay requests for appropriate care and setting, adhering to guidelines and policies, and approve services or forward requests to the 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 staff within provider networks and discharge planning teams electronically and telephonically to coordinate member care.
- Conduct discharge planning, educate providers on utilization and medical management processes, and provide clinical knowledge as a 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 per day.
- 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: Required for clinical rounds.
- Knowledge of InterQual Reviews: Essential.
A competitive annual salary range of $84,800 - $90,240, based on a 40-hour workweek.
About UsPyramid Consulting is a reputable healthcare consulting firm committed to delivering top-notch services in long-term care management.
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