Care Management Coordinator

Volt; Philadelphia (Philadelphia County); On-site; USD 55,000 - 62,000; Full time

Benefits offered by this job

health

dental

vision

term life

short term disability

AD&D

401(k)

Sick time

other types of paid leaves (as require

Employee Assistance Program (EAP)

Job summary

Volt is hiring a Care Management Coordinator in Philadelphia, PA. The role focuses on applying clinical judgment to determine medical appropriateness and discharge planning while coordinating with providers and the Medical Director as needed.

Responsibilities include using InterQual and Medical Policy to assess plans, ensuring regulatory compliance, and maintaining timely documentation. The position offers a competitive hourly pay rate and benefits. Volt is an Equal Opportunity Employer.

Qualifications

• Must hold an active PA license (or Nurse Licensure Compact to include PA).
• Prior authorization experience is required.
• Pay rate is $40.00 - $45.00 per hour.

Responsibilities

• Apply critical thinking and judgement based on medical guidelines to determine case determinations.
• Use InterQual, Medical Policy, and other references to assess medical appropriateness of proposed plans.
• Determine need for inpatient admission, continued stay, and length of stay and related services.
• Coordinate with providers on treatment plans and clarifications of medical need.
• Review plans with providers for requested services and admissions.
• Refer cases to Medical Director when criteria are not met.
• Identify discharge planning needs early and support appropriate settings.
• Collaborate with care management staff to arrange alternatives and facilitate discharge.
• Flag potential utilization issues and suggest improvements to managers.
• Route cases to Quality Management or Case Management when delays occur.
• Ensure care requests are covered by member benefit and compliant with regulations.
• Document all key functions in Care Management policies.
• Maintain accurate system data entry and perform other duties as assigned.

Skills

Active PA license

Prior authorization experience

Job description

You deserve a job you loveVolt is immediately hiring Care Management Coordinator in Philadelphia, PA

Care Management Coordinator

Responsibilities

• 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 member's 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.

Qualifications

• 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 candidate's education, work experience, work location, specific job duties, certifications, etc.

Benefits

• health
• dental
• vision
• term life
• short term disability
• AD&D
• 401(k)
• Sick time
• 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 [e-mail] or call (866) -898-0005. 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.