North Carolina Licensed Care Manager - job 1 of 2

Job Summary

A company is looking for an Episodic Care Manager.

Key Responsibilities

• Perform clinical reviews to assess and coordinate healthcare services based on medical necessity and contractual benefits
• Collaborate with providers and internal staff to ensure timely and accurate clinical evaluations and documentation
• Facilitate communication regarding case reviews and coordinate secondary reviews as needed

Required Qualifications

• Registered Nurse (RN) with 3 years of clinical experience or Licensed Practical Nurse (LPN) with 5 years of clinical experience
• Must hold a valid clinical license (NC or compact multi-state licensure)
• Strong knowledge of medical policies, benefits, and care guidelines
• Experience in clinical documentation and analysis
• Ability to work collaboratively with clinical and non-clinical staff