Episodic Care Manager Durham, NC **100% Remote** Contract $35/hr - $40/hr Our client, a nationally recognized and award-winning company in the health insurance vertical, has a contract opening for a Episodic Care Manager. They have over 4 million customers and 5,000+ employees dedicated to providing innovative solutions that simplify the healthcare system, improve efficiency and outcomes while reducing costs. **Location:** ** While the position is Remote, work from home, you must reside in North Carolina or one of the following states: Alabama, Arizona, Arkansas, Colorado, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Michigan, Mississippi, Missouri, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Wisconsin, and Wyoming. **Required Skills & Experience** + RN with 3 years of clinical experience or LPN with 5 years of clinical experience + Must have and maintain a valid and applicable clinical license (NC or compact multi-state licensure) to perform described job duties. + For Behavioral Health specific roles, other applicable licensure may be considered with a minimum of 3 years of clinical experience. **Desired Skills & Experience** + Case Management experience preferred. **What You Will Be Doing** **Daily Responsibilities** **Clinical Evaluation and Review** • Receive assigned cases for varied member services (i.e. inpatient, outpatient, DME) • Review and evaluate cases for medical necessity against medical policy, benefits and/or care guidelines and regulations. • Complete work in accordance with timeliness, production, clinical quality/accuracy and compliance standards • Provide notifications to member and/or provider, according to regulatory requirements. • Assess appropriateness for secondary case review by the Medical Director (MD) for denials and coordinate as needed. • May coordinate peer-to-peer review upon provider request when members’ health conditions do not meet guidelines **Collaboration and Documentation** • Communicate and collaborate effectively with internal and external clinical/non-clinical staff (including MDs) to coordinate work • Appropriately and fully document outcome of reviews and demonstrate the ability to interpret and analyze clinical information • Utilize detailed clinical knowledge to summarize clinical review against the criteria/guidelines to provide necessary information for MDs. ******To be eligible to contract at this client you must be able to pass a drug test and criminal background check** **You will receive the following benefits:** + Medical Insurance - Four medical plans to choose from for you and your family + Dental & Orthodontia Benefits + Vision Benefits + Health Savings Account (HSA) + Health and Dependent Care Flexible Spending Accounts + Voluntary Life Insurance, Long-Term & Short-Term Disability Insurance + Hospital Indemnity Insurance + 401(k) including match with pre and post-tax options + Paid Sick Time Leave + Legal and Identity Protection Plans + Pre-tax Commuter Benefit + 529 College Saver Plan Motion Recruitment Partners (MRP) is an Equal Opportunity Employer, including Veterans/Disability/Women. All applicants must be currently authorized to work on a full-time basis in the country for which they are applying, and no sponsorship is currently available. Employment is subject to the successful completion of a pre-employment screening. Accommodation will be provided in all parts of the hiring process as required under MRP’s Employment Accommodation policy. Applicants need to make their needs known in advance. **Posted by:** Andrew Chadwick **Specialization:** Medical / Healthcare Professional