Regional Care Manager: Utilization & Care Coordination

Wellpath; Franklin (TN); On-site; USD 75,000 - 90,000; Full time

Job summary

A healthcare organization is seeking a Regional Care Manager in Tennessee to oversee utilization reviews and care coordination across multiple sites. The role demands a strong nursing background with at least 3 years of clinical experience and expertise in InterQual criteria. Responsibilities include managing pre-certification referrals, conducting clinical reviews, and fostering collaboration with medical teams. This position offers the opportunity to make a difference in the lives of underserved patients within a dynamic environment.

Qualifications

• Previous utilization review and/or case management experience.
• Knowledge of InterQual evidence-based guideline tools.
• 3+ years of hands-on clinical experience.
• Current Nursing Licensure and preferred Case Management Certification.

Responsibilities

• Conduct clinical reviews of off-site observation, outpatient, and acute care.
• Review and document clinical information in required systems.
• Manage pre-certification referrals for various services.
• Coordinate care with medical directors and site staff.
• Collaborate with the Care Management team to develop best practices.

Skills

Utilization review

Care coordination

Clinical experience

InterQual criteria

Communication

Team collaboration

Education

Graduation from an accredited School of Nursing

Tools

MS Word

Excel

PowerPoint

Job description

A healthcare organization is seeking a Regional Care Manager in Tennessee to oversee utilization reviews and care coordination across multiple sites. The role demands a strong nursing background with at least 3 years of clinical experience and expertise in InterQual criteria. Responsibilities include managing pre-certification referrals, conducting clinical reviews, and fostering collaboration with medical teams. This position offers the opportunity to make a difference in the lives of underserved patients within a dynamic environment.