Remote Episodic Care Manager (RN)

ZP Group; United States; Remote; USD 34,000 - 48,000; Full time

Benefits offered by this job

Medical

Dental

Vision

Sick leave

401K

Job summary

Piper Companies is seeking an Episodic Care Manager to join a leading health insurance and managed care organization for a remote contract role based in North Carolina. The Episodic Care Manager will support utilization management by reviewing clinical service requests and collaborating with providers to ensure appropriate care decisions and regulatory compliance.

Responsibilities include conducting clinical reviews across inpatient and outpatient services, analyzing medical records for medical

Qualifications

• Active RN license with clinical experience; LPN with 5+ years considered.
• Prior telephonic utilization review or utilization management experience in health insurance or managed care.

Responsibilities

• Conduct clinical reviews for inpatient, outpatient, and specialty services to determine coverage eligibility.
• Analyze medical records to assess medical necessity and adherence to UM standards.
• Communicate authorization determinations to providers, members, and stakeholders.

Skills

RN License

Utilization Review

Utilization Management

Medical Necessity Review

Communication Skills

Case Management

Behavioral Health Review

Education

Active RN License

Job description

Piper Companies is seeking an Episodic Care Manager to join a leading health insurance and managed care organization for a remote contract role based in North Carolina. The Episodic Care Manager will support utilization management by reviewing clinical service requests and collaborating with providers to ensure appropriate care decisions and regulatory compliance.

Responsibilities include conducting clinical reviews across inpatient and outpatient services, analyzing medical records for medical