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Job Requirements of Case Management Analyst:
-
Employment Type:
Full-Time
-
Location:
Tennessee, US (Onsite)
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Case Management Analyst
Tailored Management Services Inc
Tennessee, US (Onsite)
Full-Time
Case Management Analyst
Pay Rate: $22.22 - $33.38, paid weekly
Location: Remote - Location Based (Nashville, IL, TX, NM, OK, MT)
Schedule: Monday-Friday, standard business hours
Assignment Length: 5 months, potential for extension/conversion depending on performance, attendance and business need
Target Start Date: 11/01/2025, pending onboarding
Benefits: Health, Dental, Vision
Position Summary
This position is responsible for pre-authorization reviews in accordance with the medical contract and regulations, medical criteria, utilization review, and quality of care.
Responsible for collaborating with healthcare providers, members, and business partners, to optimize member benefits, evaluate medical necessity and promote effective use of resources. Medical necessity reviews may include: inpatient admissions, outpatient services, surgical and diagnostic procedures, home health, durable medical equipment and out of network services but will focus on home health care requests.
JOB REQUIREMENTS:
PREFERRED JOB REQUIREMENTS:
Pay Rate: $22.22 - $33.38, paid weekly
Location: Remote - Location Based (Nashville, IL, TX, NM, OK, MT)
Schedule: Monday-Friday, standard business hours
Assignment Length: 5 months, potential for extension/conversion depending on performance, attendance and business need
Target Start Date: 11/01/2025, pending onboarding
Benefits: Health, Dental, Vision
Position Summary
This position is responsible for pre-authorization reviews in accordance with the medical contract and regulations, medical criteria, utilization review, and quality of care.
Responsible for collaborating with healthcare providers, members, and business partners, to optimize member benefits, evaluate medical necessity and promote effective use of resources. Medical necessity reviews may include: inpatient admissions, outpatient services, surgical and diagnostic procedures, home health, durable medical equipment and out of network services but will focus on home health care requests.
JOB REQUIREMENTS:
- LPN with valid, current, unrestricted clinical license in the state of operations.
- 3 years of clinical experience in physician office, hospital, or surgical setting.
- Customer service oriented to assist internal/external customers.
- Verbal and written communication skills.
- Interpersonal skills and ability to be a team player.
- Willingness and ability to travel.
- Familiar with PC or database systems. (Microsoft, Excel, PowerPoint, Outlook, SharePoint)
- Incumbents with nursing licenses in positions/departments requiring multi-state licenses are required to obtain and maintain additional current, valid, and unrestricted applicable nursing licenses in other states as determined by management. Multi-state license fees will be provided by HCSC. Incumbents with other clinical licenses are not required to obtain multi-state licenses.
- Holiday rotation (2 holidays per year)
- Weekend rotation
PREFERRED JOB REQUIREMENTS:
- Utilization review or utilization management experience
- Strong organizational, planning, and communication skills
- Working knowledge of insurance industry, medical coding (CPT/HCPCS/ICD-10)
- Knowledge of National Coverage Determinations, Local Coverage Determinations and MCG criteria are a plus.
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