Green Key Resources

Case Manager

Green Key Resources United States
Green Key Resources

Case Manager

Green Key Resources United States
1 month ago 36 applicants

See who Green Key Resources has hired for this role

Green Key Resources provided pay range

This range is provided by Green Key Resources. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more.

Base pay range

$40.00/hr - $42.00/hr
Duties

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.
  • Complete work in accordance with timeliness, production, clinical quality/accuracy and compliance standards
  • Provide notifications to member and/or provider, according to regulatory requirements.
  • Assess appropriateness for secondary case review by the Medical Director (MD) for denials and coordinate as needed.
  • May coordinate peer-to-peer review upon provider request when members’ health conditions do not meet guidelines

Collaboration and Documentation

  • Communicate and collaborate effectively with internal and external clinical/non-clinical staff (including MDs) to coordinate work
  • Appropriately and fully document outcome of reviews and demonstrate the ability to interpret and analyze clinical information
  • Utilize detailed clinical knowledge to summarize clinical review against the criteria/guidelines to provide necessary information for MDs.

Requirements

  • RN with 3 years of clinical experience or LPN with 5 years of clinical experience.
  • Must have and maintain a valid and applicable clinical license (NC or compact multi-state licensure) to perform described job duties.

  • Seniority level

    Mid-Senior level

  • Employment type

    Full-time

  • Job function

    Other

  • Industries

    Staffing and Recruiting

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