Tailored Management · 1 day ago
Case Management Analyst
United States
Contract
Remote
New Grad, Entry Level
$27/hr - $30/hrTailored Management is seeking a Licensed Practical Nurse (LPN) with insurance or managed care experience to join their team as a Case Management Analyst. In this fully remote role, you will conduct pre-authorization and utilization reviews to determine medical necessity and appropriateness of treatment plans, supporting quality care delivery while ensuring compliance with medical contracts and regulatory guidelines.
ConsultingHuman ResourcesInformation Technology
Responsibilities
Conduct pre-authorization reviews in accordance with medical contracts and regulatory requirements
Perform utilization review to validate medical necessity and appropriateness of services
Review clinical documentation using Medicare and evidence-based criteria
Evaluate treatment plans based on patient-specific clinical needs
Ensure compliance with HIPAA, corporate integrity, diversity principles, and departmental policies
Maintain productivity standards aligned with business needs
Communicate effectively with internal teams, providers, and external customers
Maintain confidentiality of sensitive company and patient information
Participate in special projects and provide updates to management as needed
Qualification
Required
Active, valid, unrestricted LPN license in state of residence (compact/multi-state licensure required if applicable)
Clinical experience in Home Health and Durable Medical Equipment (DME)
Experience in Utilization Review (UR) or Utilization Management (UM)
Strong clinical review skills with ability to apply appropriate medical criteria
Customer-service oriented with strong verbal and written communication skills
Strong interpersonal skills and ability to work collaboratively
Proficiency with PC applications and database systems
Preferred
Medicare utilization management experience preferred
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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