Tailored Management · 10 hours ago
Case Management Analyst
United States
Full-time
Remote
New Grad, Entry Level
$27/hr - $30/hrTailored Management is seeking a Case Management Analyst to perform pre-authorization and utilization reviews in a remote insurance/managed care environment. The role involves evaluating medical necessity and appropriateness of treatment plans using evidence-based criteria to support high-quality, cost-effective care.
ConsultingHuman ResourcesInformation Technology
Responsibilities
Conduct pre-authorization and utilization reviews according to medical contracts and regulatory requirements
Review clinical documentation to determine medical necessity and appropriateness of services
Apply Medicare and evidence-based criteria in clinical determinations
Collaborate with internal teams and external providers to ensure timely and accurate reviews
Maintain productivity and quality standards while adhering to HIPAA and corporate policies
Qualification
Required
LPN with a valid, unrestricted license in the state of operation (compact/multi-state licensure a plus)
Clinical experience in Home Health and Durable Medical Equipment (DME)
Experience in Utilization Review (UR) or Utilization Management (UM)
Strong communication, interpersonal, and customer service skills
Proficiency with PC-based applications and database systems
Benefits
Health
Dental
Vision
Company
Tailored Management
Tailored Management is a staffing and recruiting company that offers information technology staffing and recruitment services.
Founded in 2009
501-1000 employees
Funding
Current Stage
Late StageLeadership Team
Jeff Anderson
Managing Partner & Client Relations Executive
Savannah Deskins
Manager, Administration & Office of the CEO
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