Clinical Care Coordination Manager
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Job Description
Manager overseeing clinical referrals, approvals, and utilization for IHCS home healthcare services. Ensuring medically necessary care, compliance, efficient workflows, and exceptional patient outcomes.
Responsibilities:
- Oversee referral management and approval of home health care, DME, or infusion services
- Ensure efficient resource utilization, medically necessary services, regulatory compliance, and exceptional patient care
- Review clinical documentation
- Streamline workflows
- Collaborate with interdisciplinary teams
- Implement utilization management strategies to enhance operational efficiency and cost-effectiveness
Requirements:
- Bachelor's degree in Nursing (BSN), Healthcare Administration, or a related field
- Minimum of 3–5 years of experience in utilization management, case management, or a related healthcare setting
- At least 2 years of leadership or supervisory experience in a healthcare environment
- Strong understanding of utilization management, medical necessity criteria, and regulatory compliance (e.g., CMS, NCQA, URAC)
- Required to uphold compliance principles as outlined in the Code of Conduct and related policies
- Actively supports and participates in mandatory Corporate Compliance Program training initiatives annually or as required
- Proficient in Microsoft products (Word, Excel, PowerPoint)
- Excellent leadership, problem-solving, and decision-making abilities
- Strong communication and interpersonal skills for cross-functional collaboration
- RN-LICENSE listed under Licenses & Certifications
Benefits:
- Medical, Vision, Dental
- Short- and Long-term insurance
- 6+ Days of Holidays Pay
- 17 days of PTO
- Employer paid life insurance
- 401K with employer contribution
- Wellness program with reward incentives
- Employee recognition and reward programs
- Comprehensive paid training program
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