Utilization Management Case Manager

Job Summary

A company is looking for a Case Manager - UM II - 100% Remote.

Key Responsibilities

• Provide case management services including pre-certification, assessment, and coordination of care for assigned members
• Document all determinations and interventions in accordance with established standards and guidelines
• Monitor assigned caseloads to meet performance metric requirements and assist in identifying alternative care options

Required Qualifications

• RN, LPN, LMSW, LMHC, LMFT, LCSW, PT, OT, and/or ST license
• Master's degree in a related discipline preferred
• Experience in managed care, case management, and discharge planning
• Knowledge of Interqual and/or Milliman criteria
• Relevant clinical work experience