Clinical Referral & Case Management Lead

Physician-Care-Centers-1; West Palm Beach (FL); On-site; USD 55,000 - 70,000; Full time

Job summary

Physician-Care-Centers-1 is seeking a Referral and Patient Care Manager in West Palm Beach, FL to lead the referral processing and case management/utilization review team. The role emphasizes timely, clinically sound decisions using MCG and InterQual criteria.

The position requires clinical licensure, 3–5 years in utilization review/case management, and 1–2 years of supervisory experience, with flexibility for occasional after-hours reviews.

Qualifications

• Active, unrestricted clinical license required; RN strongly preferred.
• Minimum 3–5 years in utilization review, case management, or referral management in managed care, health plan, or clinical setting.
• Minimum 1–2 years of supervisory or team lead experience.

Responsibilities

• Lead day-to-day operations of referral processing and case management/utilization review team.
• Apply Milliman Care Guidelines (MCG) and InterQual in reviewing referrals and authorizations.
• Ensure medical necessity determinations are compliant with regulatory and accreditation standards.

Skills

Active license required

RN preferred

Supervisory experience

Utilization review knowledge

Regulatory/quality standards knowledge

Education

BSN preferred (RN)

Tools

Milliman Care Guidelines (MCG)

InterQual

Job description

Physician-Care-Centers-1 is seeking a Referral and Patient Care Manager in West Palm Beach, FL to lead the referral processing and case management/utilization review team. The role emphasizes timely, clinically sound decisions using MCG and InterQual criteria.

The position requires clinical licensure, 3–5 years in utilization review/case management, and 1–2 years of supervisory experience, with flexibility for occasional after-hours reviews.