Be an early applicantLess than 25 applicantsPosted by Agency

Company

Pyramid Consulting, Inc · 1 day ago

LTSS Service Care Manager

Florida, United States

Contract

Remote

Entry, Mid Level

$40/hr - $42/hr

2+ years exp

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ConsultingInformation Technology

Growth Opportunities

H1B Sponsor Likely

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Responsibilities

Promote the quality and cost effectiveness of medical care by applying clinical acumen and the appropriate application of policies and guidelines to emergent/urgent and continued stay reviews.

Perform review of concurrent and continued stay requests for appropriate care and setting, following guidelines and policies, and approve services or forward requests to the appropriate Physician or Medical Director for secondary review.

Complete medical necessity and level of care reviews for requested services using InterQual guidelines and refer to Medical Directors for review depending on case findings.

Collaborate with various staff within provider networks and discharge planning team electronically and telephonically to coordinate member care.

Conduct discharge planning.

Educate providers on utilization and medical management processes.

Provide clinical knowledge and act as a clinical resource to non-clinical team staff.

Enter and maintain pertinent clinical information in various medical management systems.

Nurses are expected to Review an average of 20 cases/day.

Nurses start off in our 8 week Learning Journey Program which takes them through our computer programs used to perform their job.

After learning Journey, they are placed on a 90 day ramp up with their preceptor monitoring quality and productivity performance.

Any concerns from their preceptor are escalated to the Manager for review.

Qualification

Find out how your skills align with this job's requirements. If anything seems off, you can easily click on the tags to select or unselect skills to reflect your actual expertise.

Utilization ManagementCase ManagementDischarge PlanningRN licenseInterQual reviewsMicrosoftZoomElectronic medical recordsInterQual Interrater Reliability Testing

Required

Utilization Management, Case Management, or Discharge Planning

Graduate from an Accredited School of Nursing.

Current state’s RN license.

2-4 years of experience in Utilization Management, Case Management, or Discharge Planning

Good communication skills for clinical rounds

2-4 years of hospital, managed care, UM experience

Knowledge of InterQual reviews

Microsoft, basic computer knowledge with electronic medical record programs

California Registered Nurse

InterQual Interrater Reliability Testing

Preferred

ASN or BSN preferred

Benefits

Health insurance (medical, dental, vision)

401(k) plan

Paid sick leave (depending on work location)

Company

Pyramid Consulting, Inc

Glassdoor

4.2

Pyramid Consulting, a global leader in workforce and technology solutions, empowers individuals and organizations to transform and thrive in the most challenging and competitive markets.

Founded in 1996

Alpharetta, Georgia, USA

5,001-10,000 employees

https://pyramidci.com/

H1B Sponsorship

Pyramid Consulting, Inc has a track record of offering H1B sponsorships. Please note that this does not guarantee sponsorship for this specific role. Below presents additional info for your reference. (Data Powered by US Department of Labor)

Distribution of Different Job Fields Receiving Sponsorship

Represents job field similar to this job

Trends of Total Sponsorships

2023 (77)

2022 (60)

2021 (62)

2020 (93)