Care Management Coordinator

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Volt is immediately hiring Care Management Coordinator in Philadelphia PA

As 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 members 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.

This is a full time Contract opportunity.

The ideal candidate will have:

• Must have an active PA license or a Nurse Licensure Compact to include PA.
• Prior authoritzation experience.

Pay Rate: $40.00 - $45.00 per hour.

*Pay range offered to a successful candidate will be based on several factors including the candidates education work experience work location specific job duties certifications etc.

Qualified candidates should APPLY NOW for immediate consideration! Please hit APPLY to provide the required information and we will be back in touch as soon as possible.

Benefits: Volt offers benefits (based on eligibility) that include the following: health dental vision term life short term disability AD&D 401(k) Sick time and other types of paid leaves (as required by law) Employee Assistance Program (EAP).

Volt is an Equal Opportunity Employer and prohibits any kind of unlawful discrimination and harassment. Volt is committed to the principle of equal employment opportunity for all employees and to providing employees with a work environment free of discrimination and harassment on the basis of race color religion or belief national origin citizenship social or ethnic origin sex age physical or mental disability veteran status marital status domestic partner status sexual orientation or any other status protected by the statutes rules and regulations in the locations where it operates. If you are an individual with a disability and need a reasonable accommodation to assist with your job search or application for employment please email or call (866). Please indicate the specifics of the assistance needed.

Volt does not discriminate against applicants based on citizenship status immigration status or national origin in accordance with 8 U.S.C. 1324b. The company will consider for employment qualified applicants with arrest and conviction records in a manner that complies with the San Francisco Fair Chance Ordinance the Los Angeles Fair Chance Initiative for Hiring Ordinance and other applicable laws.

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