Episodic Care Manager
Durham, North Carolina
100% Remote
Contract
$35/hr - $37/hr
Our client, a nationally recognized and award-winning company in the health insurance vertical, has a contract opening for a Episodic Care Manager. They have over 4 million customers and 5,000+ employees dedicated to providing innovative solutions that simplify the healthcare system, improve efficiency and outcomes while reducing costs.
Location: ** While the position is Remote, work from home, you must reside in North Carolina or one of the following states: Alabama, Arizona, Arkansas, Colorado, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Michigan, Mississippi, Missouri, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Wisconsin, and Wyoming.
Contract Duration: 6 + Months
Hours: will work one weekend day (Saturday or Sunday) will have one day off during the week to reach 40 hours. 8 or 10 hour shifts available.
Required Skills & Experience -RN with 3 years of clinical experience or LPN with 5 years of clinical experience
-For Behavioral Health specific roles, other applicable licensure may be considered with a minimum of 3 years of clinical experience.
-Must have and maintain a valid and applicable clinical license (NC or compact multi-state licensure) to perform described job duties.
-computer skills a must, all documentation is on line.
-MS office
-care radius and facets software ( all day everyday) Desired Skills & Experience
-insurance background a plus
-understanding Medicare is a plus
What You Will Be Doing
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 provider, 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/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/guidelines to provide necessary information for MDs.
****To be eligible to contract at this client you must be able to pass a drug test and criminal background check
Location: ** While the position is Remote, work from home, you must reside in North Carolina or one of the following states: Alabama, Arizona, Arkansas, Colorado, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Michigan, Mississippi, Missouri, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Wisconsin, and Wyoming.
Contract Duration: 6 + Months
Hours: will work one weekend day (Saturday or Sunday) will have one day off during the week to reach 40 hours. 8 or 10 hour shifts available.
Required Skills & Experience -RN with 3 years of clinical experience or LPN with 5 years of clinical experience
-For Behavioral Health specific roles, other applicable licensure may be considered with a minimum of 3 years of clinical experience.
-Must have and maintain a valid and applicable clinical license (NC or compact multi-state licensure) to perform described job duties.
-computer skills a must, all documentation is on line.
-MS office
-care radius and facets software ( all day everyday) Desired Skills & Experience
-insurance background a plus
-understanding Medicare is a plus
What You Will Be Doing
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 provider, 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/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/guidelines to provide necessary information for MDs.
****To be eligible to contract at this client you must be able to pass a drug test and criminal background check
You will receive the following benefits:
- Medical Insurance - Four medical plans to choose from for you and your family
- Dental & Orthodontia Benefits
- Vision Benefits
- Health Savings Account (HSA)
- Health and Dependent Care Flexible Spending Accounts
- Voluntary Life Insurance, Long-Term & Short-Term Disability Insurance
- Hospital Indemnity Insurance
- 401(k) including match with pre and post-tax options
- Paid Sick Time Leave
- Legal and Identity Protection Plans
- Pre-tax Commuter Benefit
- 529 College Saver Plan
Motion Recruitment Partners (MRP) is an Equal Opportunity Employer. All applicants must be currently authorized to work on a full-time basis in the country for which they are applying, and no sponsorship is currently available. Employment is subject to the successful completion of a pre-employment screening. Accommodation will be provided in all parts of the hiring process as required under MRP’s Employment Accommodation policy. Applicants need to make their needs known in advance.