Regional Care Manager

Wellpath / Correct Care Solutions; Lemoyne (Cumberland County); On-site; USD 112,507 - 125,008; Full time

Benefits offered by this job

Medical, dental, and vision insurance

Tuition assistance

Employee assistance program (EAP)

Company-paid life insurance

Wellness program

DailyPay option

Job summary

A healthcare leader is seeking a Regional Care Manager to oversee utilization review and care management in correctional healthcare settings. The ideal candidate will have a nursing background and experience in utilization and case management. Responsibilities include analyzing off-site medical care, conducting clinical reviews, and collaborating with medical directors. This role promises career growth and the chance to contribute to a mission-driven organization dedicated to providing quality care to underserved populations.

Qualifications

• Graduated from an accredited School of Nursing or obtained Care Management Certification.
• Prior experience in utilization review or case management is required.
• 3+ years of hands-on clinical experience is essential.

Responsibilities

• Oversee utilization review and daily care management across multiple sites.
• Conduct clinical reviews and apply InterQual Criteria.
• Coordinate care with medical directors and operations personnel.

Skills

Clinical review

InterQual Criteria

Utilization review

Case management

Computer proficiency

Education

Graduation from accredited School of Nursing

RN preferred

Tools

MS Word

Excel

PowerPoint

Job description

We’re on a path to better healthcare.
Join us

Compensation Information: $112,507.2 - $125,008 / year

Department (Org): Regional Office

You Matter

• Make a difference every day in the lives of the underserved
• Join a mission driven organization with a people first culture
• Excellent career growth opportunities

Join us and find a career that supports:

• Caring for overlooked, underserved, and vulnerable patients
• Diversity, equity, inclusion, and belonging
• Autonomy in a warm team environment
• Growth and training

Perks and Benefits

In addition to comprehensive benefits including medical, dental, vision, paid time off, and 401k, we foster a work-life balance for team members and their families to support physical, mental, and financial wellbeing including:

• DailyPay, receive your money as you earn it!
• Tuition assistance and dependent scholarships
• Employee assistance program (EAP) including free counseling and health coaching
• Company paid life insurance
• Tax-free health spending accounts (HSA)
• Wellness program featuring fitness memberships and product discounts
• Preferred banking partnership and discounted rates for home and auto loans

*Eligibility for perks and benefits varies based on employee type and length of service.

Why Us

Now is your moment to make a difference in the lives of the underserved.

If there is one unifying characteristic of everyone on our team, it is the deep desire to make a difference by helping society’s most vulnerable and often overlooked individuals. Every day we have the distinct honor and responsibility to show up with non-judgmental compassion to provide hope and healing to those who need it most. For those whose calling it is to serve others, now is your moment to join our mission to provide quality care to every patient with compassion, collaboration, and innovation, to live our mantra to “Always Do The Right Thing!”, and to collectively do our part to heal the world, one patient at a time.

Wellpath sees hundreds of thousands of unique individuals in their facilities month over month and a very large percent of those individuals receive direct clinical care, which includes lives saved by Narcan.

We offer ongoing training and development opportunities for licensed and unlicensed healthcare team members, and have best in class clinical resources for training, education, and point of care support.

How you make a difference

The Regional Care Manager (RCM) works collaboratively with the Utilization Medical Director, Regional Medical Directors, and Site Leadership to oversee utilization review, daily care management, and care coordination for multiple sites and states. This role is responsible for analyzing and supporting off‑site medical care during an inmate’s stay in the acute care setting. The RCM plays a crucial role in ensuring quality care for inmates and promoting efficient and effective use of resources across the correctional healthcare system.

Key Responsibilities

• Conduct clinical review and apply InterQual Criteria for off‑site observation, outpatient, and acute care as per department procedures.
• Review and document concurrent clinical information in the ERMA Care Management System, and comply with tracking and following the Medical Review procedure, including claims holds.
• Review and pre‑certify referrals for outpatient physician visits, office procedures, surgical procedures, imaging, and specialty services, including urgent, scheduled, and routine cases.
• Coordinate care with Regional Medical Directors, Site Medical Directors, and Operations personnel as needed, while routinely reviewing utilization entries for accuracy.
• Collaborate with Care Management team to develop core competencies, best practices, policies, and procedures, including regulatory compliance, while using the Customer Liability Matrix for billing information.

Qualifications & Requirements

Education

• Graduation from an accredited School of Nursing or Care Management Certification.
• RN preferred.

Experience

• Previous utilization review and/or case management and pre‑certification experience
• Knowledge of InterQual evidence‑based guideline tools
• 3+ years of hands‑on clinical experience
• Computer proficiency with specific skill in MS Word, Excel, and PowerPoint

Licenses/Certifications

• Current Nursing Licensure
• Case Management Certification preferred

We are an Equal Employment Opportunity/Affirmative Action Employer

We celebrate diversity and are committed to creating an inclusive environment for all employees.

If you are excited about a role but your experience doesn’t seem to align perfectly with every element of the job description, we encourage you to apply. You may be just the right candidate for this role or one of our many other roles.