Wellpath / Correct Care Solutions
Regional Care Manager (Midwest or Eastern Region)
Wellpath / Correct Care Solutions, Franklin, Tennessee, us, 37068
Regional Care Manager (Midwest or Eastern Region)
We are on a path to better healthcare and invite you to join a mission‑driven organization focused on underserved patients.
Overview
Make a difference every day in the lives of the underserved
Join a people‑first culture that values compassion, collaboration, and innovation
Enjoy excellent career growth opportunities
How you make a difference The Regional Care Manager (RCM) is responsible for utilization review, care coordination, and daily care management across multiple sites and states. The RCM handles pre‑certification for urgent, scheduled, and routine procedures while applying InterQual criteria and maintaining compliance with departmental policies. The RCM collaborates with medical directors, site leadership, and care management teams to enhance best practices and regulatory compliance. The role requires frequent communication with clients, providers, and site personnel, as well as travel for meetings, training, and support as needed.
Key Responsibilities
Conduct clinical reviews of off‑site observation, outpatient, and acute care using InterQual criteria.
Review and document concurrent clinical information in ERMA Care Management and Track Via systems, ensuring compliance with claims and medical review procedures.
Manage pre‑certification referrals for urgent, scheduled, and routine services including physician visits, procedures, imaging, and specialty care.
Coordinate care with medical directors, site staff, and operations to ensure accuracy in utilization data and billing processes.
Collaborate with the Care Management team to develop best practices, core competencies, and regulatory compliance procedures.
Qualifications & Requirements Education
Graduation from an accredited School of Nursing or Care Management Certification
RN preferred
Experience
Previous utilization review and/or case management and pre‑certification experience
Knowledge of InterQual evidence‑based guideline tools
3+ years of hands‑on clinical experience
Computer proficiency with MS Word, Excel, and PowerPoint
Licenses/Certifications
Current Nursing Licensure
Case Management Certification preferred
Equal Employment Opportunity/Affirmative Action Employer We celebrate diversity and are committed to creating an inclusive environment for all employees.
If you are excited about a role but your experience doesn’t seem to align perfectly with every element of the job description, we encourage you to apply. You may be just the right candidate for this, or one of our many other roles.
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Overview
Make a difference every day in the lives of the underserved
Join a people‑first culture that values compassion, collaboration, and innovation
Enjoy excellent career growth opportunities
How you make a difference The Regional Care Manager (RCM) is responsible for utilization review, care coordination, and daily care management across multiple sites and states. The RCM handles pre‑certification for urgent, scheduled, and routine procedures while applying InterQual criteria and maintaining compliance with departmental policies. The RCM collaborates with medical directors, site leadership, and care management teams to enhance best practices and regulatory compliance. The role requires frequent communication with clients, providers, and site personnel, as well as travel for meetings, training, and support as needed.
Key Responsibilities
Conduct clinical reviews of off‑site observation, outpatient, and acute care using InterQual criteria.
Review and document concurrent clinical information in ERMA Care Management and Track Via systems, ensuring compliance with claims and medical review procedures.
Manage pre‑certification referrals for urgent, scheduled, and routine services including physician visits, procedures, imaging, and specialty care.
Coordinate care with medical directors, site staff, and operations to ensure accuracy in utilization data and billing processes.
Collaborate with the Care Management team to develop best practices, core competencies, and regulatory compliance procedures.
Qualifications & Requirements Education
Graduation from an accredited School of Nursing or Care Management Certification
RN preferred
Experience
Previous utilization review and/or case management and pre‑certification experience
Knowledge of InterQual evidence‑based guideline tools
3+ years of hands‑on clinical experience
Computer proficiency with MS Word, Excel, and PowerPoint
Licenses/Certifications
Current Nursing Licensure
Case Management Certification preferred
Equal Employment Opportunity/Affirmative Action Employer We celebrate diversity and are committed to creating an inclusive environment for all employees.
If you are excited about a role but your experience doesn’t seem to align perfectly with every element of the job description, we encourage you to apply. You may be just the right candidate for this, or one of our many other roles.
#J-18808-Ljbffr