North Carolina Licensed Care Manager

A company is looking for an Episodic Care Manager - Medicare Advantage.

Key Responsibilities

Perform clinical reviews to assess and coordinate healthcare services based on medical necessity and benefits

Collaborate with providers and internal staff to ensure high-quality, cost-effective care delivery

Document clinical evaluations and communicate outcomes effectively to relevant stakeholders

Required Qualifications

Registered Nurse (RN) with 3 years of clinical experience or Licensed Practical Nurse (LPN) with 5 years of clinical experience

Must hold a valid and applicable clinical license (NC or compact multi-state licensure)

Experience in clinical evaluation and documentation

Ability to interpret and analyze clinical information

Familiarity with medical policies, benefits, and care guidelines