What are the responsibilities and job description for the Managed Care Utlitization Specialist position at The Wellstone Group?
Case Manager – North Little Rock, AR (72113)
Are you a dedicated healthcare professional with experience in long-term care? We are looking for a Case Manager to ensure efficient resource utilization while maintaining high-quality patient care within our managed care system. This role is crucial in overseeing patient care services, ensuring compliance with policies and regulations, and driving quality improvement initiatives.
Key Responsibilities:
-Utilization Review:Conduct thorough assessments of patient cases, including pre-authorizations and concurrent reviews, to ensure the necessity and appropriateness of care.
- Collaboration: Work closely with healthcare providers, case managers, and interdisciplinary teams to facilitate effective patient care planning and resource allocation.
- Regulatory Compliance: Ensure adherence to all relevant state and federal regulations, accreditation standards, and company policies.
- Quality Improvement: Participate in initiatives aimed at enhancing patient outcomes and improving operational efficiency.
- Appeals Management:Review and manage appeals related to utilization decisions, ensuring thorough documentation and timely responses.
Qualifications (Required):
- Must have long-term care experience.
- Active LPN, COTA, or PTA license.
- Minimum of one year of experience in utilization management, case management, or a related healthcare field, preferably within a managed care environment.
- Strong understanding of healthcare regulations, managed care principles, and clinical guidelines.
- Excellent analytical, problem-solving, and communication skills.
- Proficiency in healthcare management software and data analysis tools.
Preferred Skills:
- Experience working with electronic health records (EHR) systems.
- Ability to thrive in a fast-paced, team-oriented environment.
Work Environment:
This is an in-office position, requiring daily commute to our North Little Rock, AR office.
If you meet the qualifications and are passionate about improving patient care, we encourage you to apply today!
