Ohio Licensed Patient Care ManagerVirtualVocations • Ontario, California, United States
Ohio Licensed Patient Care Manager
VirtualVocations • Ontario, California, United States
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A company is looking for a Patient Care Resource Manager - Retrospective Review.
Key Responsibilities
Conduct retrospective reviews of medical services to assess medical necessity and compliance with guidelines
Support the Utilization Management team with prior authorizations and concurrent reviews
Analyze claims data to identify trends and develop action plans for process improvements
Required Qualifications
Bachelor's degree in nursing and a current Ohio Registered Nurse license
Minimum of three years' experience in a clinical setting, with a focus on utilization or case management
Knowledge of managed health care concepts and experience with national guidelines (e.g., MCG)
Proficiency in Microsoft Office applications and electronic health records
Strong understanding of HIPAA regulations and compliance requirements
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Patient Care Manager • Ontario, California, United States
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