Episodic Care Manager

Job Description We're hiring an Episodic Case Manager to join the Medicare Utilization Management Team! The Episodic Care Manager is responsible for performing clinical reviews to assess, facilitate, and coordinate the delivery of health care services for members based on medical necessity and contractual benefits. Effectively coordinate with providers, members, and internal staff to support the delivery of high quality and cost-effective care across the health care system. What You'll Do Clinical Evaluation and Review • Receive assigned cases for varied member services (i.e. inpatient, outpatient, DME) • Review and evaluate cases for medical necessity against medical policy, benefits and/or care guidelines and regulations.…