UM Case Manager

@ Lensa

Overview

Lensa, a leading career site in the US, promotes jobs on behalf of direct clients, recruitment ad agencies, and marketing partners. This UM Case Manager role is 100% remote.

Duties & Responsibilities

The UM Case Manager provides case management services for assigned member caseloads including:

• Risk identification, preadmission, concurrent, and retrospective reviews based on clinical documentation.
• Assessment of medical, psychological, and social issues needing intervention.
• Coordinating with primary care physicians and other providers for treatments and authorizations.
• Negotiating rates with non-partner providers as applicable.
• Documenting all determinations, notifications, interventions and telephone encounters per standards.
• Reporting and escalating questionable healthcare services.
• Monitoring caseload to meet performance metrics.
• Serving as a clinical resource for multi-disciplinary teams.
• Identifying alternative care options and facilitating discharge planning.
• Occasional overtime and additional duties as assigned.

Minimum Qualifications

RN, LPN, LMSW, LMHC, LMFT, LCSW, PT, OT, and/or ST license. For CASAC positions: Credentialed Alcohol and Substance Abuse Counselor.

Preferred Qualifications

• Masters degree in a related discipline.
• Experience in managed care, case management, and discharge planning.
• Certified Case Manager with Interqual and/or Milliman knowledge.
• Knowledge of CMS or NYSDOH regulations.
• Relevant clinical experience and strong documentation skills.
• Proficiency in Outlook, Word, Excel, PowerPoint, and Adobe Acrobat.
• Demonstrated critical thinking and ability to manage large caseloads.

Equal Opportunity

Lensa is an equal opportunity employer and evaluates applicants without regard to any protected status.

Contact

If you have any questions about this posting, please contact support@lensa.com.

Key Skills/Competency

• Case Management
• Risk Assessment
• Clinical Documentation
• Regulatory Compliance
• Managed Care
• Utilization Review
• Discharge Planning
• Healthcare Coordination
• InterQual/MCG
• Communication