Clinical Care Coordination Manager

This is a fully remote position, open to applicants in Florida.

📋 Description

• Manage the referral process and authorization for home health care, durable medical equipment (DME), or infusion services.

• Ensure effective use of resources, medically necessary services, regulatory compliance, and outstanding patient care.

• Evaluate clinical documentation.

• Optimize workflows.

• Work in collaboration with interdisciplinary teams.

• Execute utilization management strategies to improve operational efficiency and cost-effectiveness.

⛳️ Requirements

• Bachelor's degree in Nursing (BSN), Healthcare Administration, or a related discipline.

• 3 to 5 years of experience in utilization management, case management, or a similar healthcare environment.

• A minimum of 2 years of leadership or supervisory experience in a healthcare setting.

• In-depth knowledge of utilization management, medical necessity criteria, and regulatory compliance (e.g., CMS, NCQA, URAC).

• Must adhere to compliance principles as stated in the Code of Conduct and related policies.

• Actively engages in mandatory Corporate Compliance Program training sessions annually or as required.

• Proficient in Microsoft Office Suite (Word, Excel, PowerPoint).

• Exceptional leadership, problem-solving, and decision-making skills.

• Strong communication and interpersonal abilities for effective cross-functional collaboration.

• RN-LICENSE must be included under Licenses & Certifications.

🏝️ Benefits

• Medical, Vision, Dental coverage.

• Short- and Long-term insurance options.

• Over 6 Days of Holiday Pay.

• 17 days of Paid Time Off (PTO).

• Employer-funded life insurance.

• 401K plan with employer contributions.

• Wellness program featuring reward incentives.

• Employee recognition and rewards initiatives.

• Comprehensive paid training program.