Episodic Care Manager

Durham, North Carolina

100% Remote

Contract

$35/hr - $39/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.

** 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

Required Skills & Experience

• RN with 3 years of clinical experience or LPN with 5 years of clinical experience or LCSW with 3 years of clinical experience or LPC with 3 years of experience or other applicable Behavioral Health clinical licenses with 3 years of experience.

• BCBA credentials required.

• Must have and maintain a valid and applicable clinical license (NC or compact multi-state licensure) to perform described job duties.

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 is an Equal Opportunity Employer, including Veterans/Disability/Women. 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. Accommodation will be provided in all parts of the hiring process as required under Motion Recruitment Employment Accommodation policy. Applicants need to make their needs known in advance.

Posted by: Andrew Chadwick

Specialization: Medical / Healthcare Professional