Case Manager- Utilization Review

Case Manager

Job Description

As a Case Manager in Utilization Review, you will perform integrated case management and disease management activities, demonstrating clinical judgment and independent analysis. You will collaborate with members and those involved with members' care including clinical nurses and treating physicians. Your role involves determining, developing, and implementing a plan of care based on accurate and comprehensive assessment of the member's needs. You will apply detailed knowledge of established medical/departmental policies, clinical practice guidelines, community resources, contracting and community care standards to each case. Responsibilities include complex case handling, promoting the delivery of quality, cost-effective health care services based on medical necessity and contractual benefits. You will also provide guidance to the provider network via telephone triage, perform effective discharge planning, collaborate with member support system and health care professionals involved in the continuum of care, and make referrals to appropriate departments.

Hard Skills

• Licensed RN

• acute care experience or surgery experience/ Case Management Experience

• Knowledge of MCG Medical Necessity criteria

• Understanding Medical Necessity Review

Soft Skills

• clinical judgment
• independent analysis
• effective communication
• collaboration

Job Type

This is a Contract-to-Hire position with a duration of 6 Month(s).

Work Site

This is a fully on-site position in Oklahoma City, Oklahoma City.

About Actalent

Actalent is a global leader in engineering and sciences services and talent solutions. We help visionary companies advance their engineering and science initiatives through access to specialized experts who drive scale, innovation and speed to market. With a network of almost 30,000 consultants and more than 4,500 clients across the U.S., Canada, Asia and Europe, Actalent serves many of the Fortune 500.

Diversity, Equity & Inclusion

At Actalent, diversity and inclusion are a bridge towards the equity and success of our people. DE&I are embedded into our culture through:

• Hiring diverse talent

• Maintaining an inclusive environment through persistent self-reflection

• Building a culture of care, engagement, and recognition with clear outcomes

• Ensuring growth opportunities for our people

The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing process due to a disability, please email actalentaccommodation@actalentservices.com for other accommodation options.