Case Management Analyst

Case Management Analyst#26-12026 Nashville, TN All On-site Job Description Case Management Analyst (UM) This position is responsible for pre-authorization reviews in accordance with the medical contract and regulations, medical criteria, utilization review, and quality of care.

JOB REQUIREMENTS

1. LPN with valid, current, unrestricted clinical license in the state of operations. 2. Clinical experience in Home Health and DME 3. Utilization review or utilization management experience 4. Clinic Review for medical necessity based on specific needs of the patient and evidence supporting it and appropriateness of services. 5. Clinical Reviewer with relevant expertise and Medicare UM experiences responsible for making determinations utilizing the correct criteria and consider the clinical information provided. 6. Customer service oriented to assist internal/external customers. 7. Verbal and written communication skills. 8. Interpersonal skills and ability to be a team player. 9. Familiar with PC or database systems. 10. Incumbents with nursing licenses in positions/departments requiring multi-state licenses or compact licensure within your residential state. 11. Comply with HIPAA, Diversity Principles, Corporate Integrity, Compliance Program policies and other applicable corporate and departmental policies. Maintain complete confidentiality of company business. 12.Maintain communication with management regarding development within areas of assigned responsibilities and perform special projects as required or requested. 13. Maintain production requirements based on established department business needs.

EEO:

"Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of - Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans."