Case Manager – Utilization Management

🔥 1 hour 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.

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

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 • Work collaboratively and provide leadership to the healthcare team • Examine records for medical treatments and interventions to avoid payment denial and optimize reimbursement • Assess appropriateness of treatments, effectiveness, timing, and setting • Determine observation versus inpatient level of care based on medical necessity • Assess patients for discharge planning and appropriateness of level of care • Minimize and assist with barriers to discharge • 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/Case Management teams regarding level-of-care determination and reimbursement • Work with the Physician Advisory team on concurrent denials • Monitor patient flow through multidisciplinary rounds and help implement process improvements • 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, 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