Explore an exciting opportunity as a Lensa in United States, . This Full-time role is ideal for professionals interested in the Internet Publishing sector and offers hands-on experience in the Other department .
Rated 4.3/5 by employees, this opening is perfect for candidates at the Entry level level. Posted 4 hours ago, and still accepting applications — don’t miss out.
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“Lensa” Company Job Overview
- Company Name: Lensa
- Work Type: Full-time
- Rating: 4.3 / 5
- Location: United States,
- Industry: Internet Publishing
- Department: Other
- Experience Level: Entry level
Case Manager – UM II Remote Part Time Remote Job Details
Lensa is a career site that helps job seekers find great jobs in the US. We are not a staffing firm or agency. Lensa does not hire directly for these jobs, but promotes jobs on LinkedIn on behalf of its direct clients, recruitment ad agencies, and marketing partners. Lensa partners with DirectEmployers to promote this job for Health First. Clicking “Apply Now” or “Read more” on Lensa redirects you to the job board/employer site. Any information collected there is subject to their terms and privacy notice.
The Case Manager, Utilization Management coordinates the care plan for assigned members and conducts pre-certification, concurrent review, discharge planning, and case management as assigned. The Case Manager, Utilization Management is also responsible for efficient utilization of health services and optimal health outcomes for members, as well as meeting designated quality metrics.
Duties/Responsibilities
Provides case management services for assigned member caseloads which includes:
- Pre-certification performing risk-identification, preadmission, concurrent, and retrospective reviews to evaluate the appropriateness and medical necessity of treatments and service utilizations based on clinical documentation, regulatory, and InterQual/MCG criteria
- Assessment – identifying medical, psychological, and social issues that need intervention.
- Coordination – partnering with PCP and other medical providers to coordinate treatments, collateral services, and service authorizations. Negotiates rates with non-partner providers, where applicable. Ensures appropriate access and utilization of a full continuum of network and community resources to support health and recovery
- Documenting – documenting all determinations, notifications, interventions, and telephone encounters in accordance with established documentation standards and regulatory guidelines.
- Reports and escalates questionable healthcare services
- Meets performance metric requirements as part of annual performance appraisals
- Monitors assigned case load to meet performance metric requirements
- Functions as a clinical resource for the multi-disciplinary care team in order to maximize HF member care quality while achieving effective medical cost management
- Assists in identifying opportunities for and facilitating alternative care options based on member needs and assessments
- Occasional overtime as necessary
- Additional duties as assigned
Minimum Qualifications
- RN, LPN, LMSW, LMHC, LMFT, LCSW, PT, OT, and/or ST license
- For CASAC positions only: Credentialed Alcohol and Substance Abuse Counselor
Preferred Qualifications
- Masters degree in a related discipline
- Experience in managed care, case management, identifying alternative care options, and discharge planning
- Certified Case Manager
- Interqual and/or Milliman knowledge
- Knowledge of Centers for Medicare & Medicaid Services (CMS) or New York State
- Department of Health (NYSDOH) regulations governing medical management in managed care
- Relevant clinical work experience
- Intermediate Outlook, Basic Word, Excel, PowerPoint, Adobe Acrobat skills.
- Demonstrated critical thinking and assessment skills to ensure member care plans are followed.
- Demonstrated ability to manage large caseloads and effectively work in a fast-paced environment
WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.
If you have questions about this posting, please contact support@lensa.com
