Regional Care Manager Role based in the Midwest or Western Region. This position manages utilization review, care coordination, and daily care management across multiple sites and states. Travel required for meetings, training, and support.
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 Graduation from an accredited School of Nursing or Care Management Certification
RN preferred
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
We are an Equal Employment Opportunity Employer We are committed to fostering, cultivating, and preserving a culture of uniqueness. We celebrate a variety of backgrounds and are committed to creating an inclusive environment for all employees.
Why Us 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.
Details Deadline to apply to this position is contingent upon applicant volume. Those positions located in Colorado will have a specific deadline posted in the job description. We are an Affirmative Action Employer in accordance with applicable state and local laws.