Case Manager – Utilization Management

🔥 12 hours ago

🌴 South Carolina – Remote

🌴 South Carolina – Remote

⏱ Part Time

🟢 Junior

👔 Manager

👻 Ghost score 11%

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 • 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 care 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 and take actions for continuous improvement • Communicate with Utilization Management, Case Management, and Physician Advisory teams regarding level-of-care determinations, reimbursement, and concurrent denials • Monitor patient flow through multidisciplinary rounds and implement processes to decrease delays • Advocate for Emergency Department patients by identifying needs and coordinating services and resources • Ensure critical plan-of-care information is communicated to patients, families, and healthcare team members • Perform other duties 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 • Ability to cover various populations across the organization, including the Emergency Department

🏖️ Benefits

• Part-time schedule • Equal opportunity employer