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Care Manager Licensed - Remote
| Company | McLaren Integrated HMO Group |
| Address | , Indianapolis, In |
| Employment type | FULL_TIME |
| Salary | |
| Expires | 2023-06-11 |
| Posted at | 1 year ago |
About Us
McLaren Health Care is a fully integrated health network committed to quality, evidence-based patient care with locations in Michigan, Indiana and Ohio. The McLaren system includes 14 hospitals in Michigan and Ohio, ambulatory surgery centers, imaging centers, a primary and specialty care physician network, commercial and Medicaid HMOs, home health, infusion and hospice providers, pharmacy services, a clinical laboratory network and a wholly owned medical malpractice insurance company. McLaren operates Michigan’s largest network of cancer centers and providers, anchored by the Karmanos Cancer Institute, one of only 51 National Cancer Institute-designated comprehensive cancer centers in the U.S.
We are looking for a Care Manager, Medical Management, to join us in leading our organization forward.
McLaren Integrated HMO Group (MIG), a division of McLaren Health Care Corporation, is an organization with a culture of high performance and a mission to help people live healthier and more satisfying lives.
McLaren Health Plan and MDwise, Inc., subsidiaries of MIG, value the talents and abilities of all our employees and seeks to foster an open, cooperative and dynamic environment in which employees and the health plans can thrive. As an employee MIG, you will be a part of a dynamic organization that considers all our employees as leaders in driving the organization forward and delivering quality service to all our members.
McLaren Health Plan is our Michigan-based health plan dedicated to meeting the health care needs of each of our Michigan members. Learn more about McLaren Health Plan at https://www.mclarenhealthplan.org
MDwise is our Indiana-based health plan, working with the State of Indiana and Centers for Medicare and Medicaid Services to bring you the Hoosier Healthwise and Healthy Indiana Plan health insurance programs. Learn more about MDwise, Inc. at https://www.mdwise.org/
Position Summary:
Responsible for the review and authorization of all services to the members, utilizing expert knowledge of screening criteria, clinical criteria and research ability if no criteria exists. Uses independent judgment, when necessary, within scope of practice. Participates in the medical management of members in all product lines. Works with the PCP, the member, the Case Manager or Manager, Med Management and management to promote the delivery of quality services at the most appropriate and cost-effective setting. Performs as the member advocate with emphasis on education regarding managed care, disease management, care management, case management and PCP treatment plans. Monitors member’s utilization patterns for identification of high risk, and under and overuse of services. Collaborates with Case Manager or Manager, Med Management, Medical Director and senior management on complex cases.
Equal Opportunity Employer of Minorities/Females/Disabled/Veterans
This is a fully remote position.
#LI-AK1
Qualifications:
Required:
- A valid current unrestrictive license in the state doing business in, in one of the following: LPN, LCSW, LMHC, LMSW, LMFT, LPC
- 2 years’ experience in Utilization Management, Medical Management, Case Management
- 3 years clinical experience
Preferred:
- 5 years clinical experience
- Understanding of claims administration, including CPT-4 codes, revenue codes, HCPCS codes, DRGs, etc.
- Five (5) years’ experience and knowledge of HMO, PPO, TPA, PHO and Managed Care functions (e.g utilization management, medical management, case management).
- Associate degree in nursing, health care, or related field.
- Daily Work Times: 8:30 am - 5:00 pm
- On Call: No
- Schedule: Full-time
- Hours Per Pay Period: 80
- Requisition ID: 23002184
- Weekends: No
Per Centers for Medicare & Medicaid Services (CMS) regulations, all McLaren employees must be vaccinated for COVID-19 by January 4, 2022. The regulation permits exemptions for employees with qualified medical disabilities or religious beliefs.
Equal Opportunity Employer
McLaren Health Care is an Equal Opportunity Employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sexual orientation, gender identification, age, sex, marital status, national origin, disability, genetic information, height or weight, protected veteran or other classification protected by law.
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