Case Manager – Utilization Management

🔥 0 minutes ago

🌴 South Carolina – Remote

🌴 South Carolina – Remote

⏰ Full Time

🟢 Junior

👔 Manager

👻 Ghost score 10%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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McLeod Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded over a century ago

🏥 Healthcare

⚕️ Healthcare Insurance

Healthcare • Healthcare Insurance

McLeod Health is a healthcare organization providing a wide range of medical services in multiple locations, including Florence, Cheraw, Clarendon, Dillon, Loris, Seacoast, and Carolina Forest. It offers specialized care across various departments such as behavioral health, cancer treatment, cardiology, orthopedics, neurology, emergency and trauma services, as well as children's and women's healthcare. McLeod Health is committed to community involvement and offers wellness programs, occupational health, and patient support services. The organization is recognized for its dedication to patient safety and advanced healthcare services, including telehealth options, rehabilitation, and a variety of outpatient services. It also supports medical education through physician employment and residency programs.

📋 Description

• Oversee the process of care delivered to patients and provide leadership to the healthcare team • Examine medical records, treatments, interventions, and levels of care for medical necessity and reimbursement optimization • Coordinate and facilitate patient care progression throughout the continuum of care • Ensure care plans and services are patient-focused, high quality, efficient, and cost-effective • Meet with patients and families to assess needs and develop individualized continuing care plans with physicians • Monitor length of stay and ancillary resource use, taking action for continuous improvement • Communicate with Utilization Management and Case Management teams on level-of-care determinations and reimbursement • Work with the Physician Advisory team on concurrent denials and appropriate level of care before billing • Monitor patient flow through multidisciplinary rounds and implement process improvements to decrease delays • Advocate for Emergency Department patients by identifying needs and coordinating services and resources • Communicate plan-of-care elements to patients, families, and healthcare team members • Cover various patient populations across the organization, including the Emergency Department • Perform other duties as requested by the Case Manager Supervisor and/or Director

🎯 Requirements

• 1-2 years of recent acute care hospital experience required • Data entry/computer experience required • Registered Nurse license/certification required