A Client Innova Solutions Is Immediately Hiring for
Care Management CoordinatorPosition type: Full Time - Contract
Duration: 03 Months
Location: Philadelphia, PAAs a Care Management Coordinator you will:- Apply critical thinking and judgement skills based on advanced medical knowledge to cases utilizing specified resources and guidelines to make case determination. Utilizes resources such as; InterQual, Care Management Policy, Medical Policy and Electronic Desk References to determine the medical appropriateness of the proposed plan.
- Utilizes the medical criteria of InterQual and/or Medical Policy to establish the need for inpatient, continued stay and length of stay, procedures and ancillary services.
- servicing providers regarding treatment plans/plan of care and clarifies medical need for services.
- Reviews treatment plans/plan of care with provider for requested services/procedures, inpatient admissions or continued stay, clarifying medical information with provider if needed.
- Identifies and refers cases in which the plan of care/services are not meeting established criteria to the Medical Director for further evaluation determination
- Performs early identification of members to evaluate discharge planning needs.
- Collaborates with case management staff or physicians to determine alternative settings at times and provide support to facilitate discharge to the most appropriate setting.
- Reports on potential utilization issues or trends to designated managers and recommendations for improvement.
- Appropriately refers cases to the Quality Management Department and/or Care Management and Coordination Manager when indicated to include delays in care.
- Appropriately refers to Case and Disease Management.
- Ensures request is covered within the member's benefit plan.
- Ensures utilization decisions are compliant with state, federal and accreditation regulations.
- Meets or exceeds regulatory turnaround time and departmental productivity goals when processing referral/authorization requests.
- Ensures that all key functions are documented via Care Management and Coordination Policy.
- Maintains the integrity of the system information by timely, accurate data entry.
- Performs additional duties assigned.
The Ideal Candidate will have:- Must have an active PA license or a Nurse Licensure Compact to include PA.
- Prior authoritzation experience.
Qualified candidates should
APPLY NOW for immediate consideration!
This position is only open to applicants who can be engaged on a W-2 basis.Please hit APPLY to provide the required information, and we will be back in touch as soon as possible.
We are currently interviewing to fill this and other similar positions. If this role is not a fit for you, we do offer a referral bonus program for referrals that we successfully place with our clients, subject to program guidelines.
ASK ME HOW.Thank you!
Thank you!
Gandam Meghana
[email protected]PAY RANGE AND BENEFITS:Pay Range*: $40 - $45 per hour
*Pay range offered to a successful candidate will be based on several factors, including the candidate's education, work experience, work location, specific job duties, certifications, etc.
Benefits: Innova Solutions offers benefits (based on eligibility) that include the following: Medical & pharmacy coverage, Dental/vision insurance, 401(k), Health saving account (HSA) and Flexible spending account (FSA), Life Insurance, Pet Insurance, Short term and Long term Disability, Accident & Critical illness coverage, Pre-paid legal & ID theft protection, Sick time, and other types of paid leaves (as required by law), Employee Assistance Program (EAP).
