Regional Care Manager: Care Coordination & Utilization

Wellpath / Correct Care Solutions; Franklin (TN); On-site; USD 70,000 - 95,000; Full time

Benefits offered by this job

Comprehensive medical, dental, and vision benefits

Paid time off

401k

Tuition Assistance

Employee Assistance Program

Wellness program

DailyPay access

Job summary

A healthcare organization in Tennessee is seeking a Regional Care Manager to coordinate care management across multiple locations. The ideal candidate will have experience in utilization review and hold a current nursing license. Responsibilities include managing clinical reviews using InterQual criteria, handling pre-certifications for procedures, and ensuring adherence to compliance standards. This role demands strong communication skills and a commitment to improving care delivery for underserved populations. A robust benefits package is offered, supporting work-life balance and professional development.

Qualifications

• 3+ years of hands-on clinical experience.
• Previous utilization review or case management experience required.
• Current Nursing Licensure necessary.

Responsibilities

• Conduct clinical reviews of off-site care using InterQual criteria.
• Manage pre-certification referrals for various services.
• Coordinate care with medical directors and site staff.

Skills

Utilization review knowledge

Clinical management skills

InterQual criteria familiarity

Communication skills

Computer proficiency

Education

Graduation from an accredited School of Nursing

Care Management Certification

Tools

MS Word

Excel

PowerPoint

Job description

A healthcare organization in Tennessee is seeking a Regional Care Manager to coordinate care management across multiple locations. The ideal candidate will have experience in utilization review and hold a current nursing license. Responsibilities include managing clinical reviews using InterQual criteria, handling pre-certifications for procedures, and ensuring adherence to compliance standards. This role demands strong communication skills and a commitment to improving care delivery for underserved populations. A robust benefits package is offered, supporting work-life balance and professional development.