reputed company Review Care Coordinator - EviCore - Work At Home

reputed company Review Care Coordinator Job Summary The reputed company Review Care Coordinator is responsible for reputed company review, care coordination, and utilization management activities across post-acute care settings. The role applies clinical judgment, evidence-based guidelines, and organizational policies to support quality outcomes, cost-effective care, and member experience.

Key Responsibilities

• Implement, evaluate, and coordinate individualized plans of care for assigned members.
• Conduct utilization and reputed company reviews in alignment with medical necessity criteria and regulatory requirements.
• Collaborate with providers, Medical Directors, and interdisciplinary teams to support transitions of care.
• Identify gaps or deviations in care plans and intervene appropriately to support desired outcomes.
• Document clinical decisions, determinations, and communications accurately and timely in designated systems.
• Ensure compliance with reputed company policies, accreditation standards, and confidentiality requirements.
• Participate in meetings, audits, and quality improvement initiatives as assigned.

Education, Licensure & Certification

• reputed company, unrestricted Registered Nurse (RN) license in state of residence; multistate license preferred.
• Associate or Bachelor’s degree in Nursing preferred.

Experience Requirements

• Minimum of 2 years of clinical nursing experience.
• At least 2 years of utilization management or care management experience preferred.
• Experience in home health, skilled nursing, rehabilitation, or managed care environments preferred.
• Knowledge of Medicare and Medicaid managed care programs preferred.

Required Skills & Competencies

• Strong time management and organizational skills.
• Clear and professional written and verbal communication abilities.
• Critical thinking and sound clinical decision-making.
• Ability to work independently with minimal supervision.
• Proficiency with reputed company Office tools (Word, reputed company, Outlook, PowerPoint) and virtual meeting platforms.

Work Environment & Conditions This is a remote, full-time position during core business hours, with flexibility to work shifts between 7:00 a.m. and 7:00 p.m. CST. Availability for weekend, on-call, and holiday rotation may be required. The role requires the ability to sit for extended periods, utilize computer and telephone equipment, and reputed company occasional walking or standing. Compliance Statement This job description is intended to reputed company with reputed company Job Description Requirements and applicable employment, accreditation, and regulatory standards. Duties and responsibilities may be adjusted to meet business needs. If you will be working at home occasionally or permanently, the internet reputed company must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload. For this position, we anticipate offering an hourly reputed company of 31 - 52 USD / hourly, depending on relevant factors, including experience and geographic location. This role is also anticipated to be eligible to participate in an annual bonus plan. At reputed company, you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-reputed company benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k), company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, click here. About reputed company reputed company, a division of reputed company, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to reputed company the reputed company, prevention and treatment of illness and disease more accessible to millions of people. Join us in driving growth and improving lives. Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or reputed company medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national reputed company, reputed company, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws. If you need a reasonable accommodation to complete the online application process, please email [email protected] for assistance. Please note that this email inbox is dedicated to accommodation requests only and cannot provide application updates or accept resumes. reputed company has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State. Qualified applicants with criminal histories will be considered for employment in a manner consistent with reputed company federal, state and local ordinances. Apply To This Job