What are the responsibilities and job description for the Case Manager position at Concord Medical Group?
Do you thrive in a growing and fast paced company environment? We pride ourselves on offering a team centric and fun working atmosphere. You will be given the empowerment and autonomy to successfully perform your role while enjoying a small company feel. We are seeking a Case Manager to join our team!
Chart Review Responsibilities
- Performs comprehensive reviews of patient charts to assess medical necessity and appropriateness of hospital admissions based on established clinical criteria and organizational guidelines.
- Evaluates documentation to ensure alignment with regulatory standards and payer requirements, supporting accurate and timely authorization processes.
- Identifies potential quality concerns, such as gaps in care, deviations from best practices, or documentation inconsistencies, and escalates findings to the appropriate clinical or quality teams.
- Collaborates with physicians, nursing staff, and interdisciplinary teams to clarify clinical information and support effective care coordination.
- Maintains detailed records of chart reviews and outcomes to support compliance, performance improvement, and audit readiness.
Qualifications:
- At least 2 years of experience in a relevant role. 3 years of experience is preferred.
- Working experience with InterQual and Milliman Criteria
- Certified Case Manager (CCM) or Accredited Case Manager (ACM) Preferred.
- Bachelor's Degree
The work location of this position is flexible, with remote or hybrid work schedules possibilities if desired.
Health benefits, 401k, PTO, paid holidays and flexible work schedules available.