Concurrent Review Care Manager

Join VillageMD as a Concurrent Review Care Manager

Join the frontlines of today's healthcare transformation

Why VillageMD?

At VillageMD, we're looking for a Concurrent Review Case Manager to help us transform the way primary care is delivered and how patients are served. As a national leader on the forefront of healthcare, we've partnered with many of today's best primary care physicians. We're equipping them with the latest digital tools. Empowering them with proven strategies and support. Inspiring them with better practices and consistent results.

We're creating care that's more accessible. Effective. Efficient. With solutions that are value-based, physician-driven and patient-centered. To accomplish this, we're looking for individuals who share our sense of excellence, are ready to embrace change, and never settle for the status quo. Individuals who have the confidence to lead but the humility to never stop learning.

Could this be you?

The Concurrent Review Care Manager is responsible for onsite and telephonic patient monitoring, the documentation of medical treatment, and comparing treatment to established criteria to determine if it meets established guidelines. In addition, this Care Manager monitors patients’ progress toward recovery for early identification of continuing care needs to facilitate discharge for specified populations. You will coordinate care by serving as the main point of contact, advocate and resource for the patient, their family and their physician. This position works closely with medical management, primary care physician leadership, and various internal departments.

How you can make a difference

• Provide clinical education and act as a clinical resource to non-clinical team staff
• Promote the quality and cost effectiveness of medical care by applying clinical acumen and the appropriate application of policies and guidelines to emergent/urgent and continued stay reviews
• Develop and maintain effective professional working relationships with assigned PCP practice(s)
• Engage patients in a variety of settings, determined by program models and initiatives
• Perform in-hospital, onsite review of emergent/urgent and continued stay requests for appropriate care and setting in accordance with guidelines and policies, and approve services or forward requests to the appropriate physician or medical director with recommendations for other determinations; make appropriate discharge planning decisions
• In the hospital setting, review patients’ charts, manage discharge planning, and coordinate with the transitional care management team for scheduling
• Complete medical necessity and level of care reviews for requested services using clinical judgment and refer to medical director for review depending on case findings as necessary
• Educate providers on utilization and medical management processes
• Employ motivational interviewing skills to elicit optimal member engagement/outcome
• Maintain a core understanding of population management as it specifically relates to high-risk patients

Skills for success

• The ability to be flexible in an ambiguous and dynamic environment
• Schedule flexibility that allows for occasional evening / weekend coverage for patient care coordination and support
• The ability to adapt quickly to changing demands in the healthcare industry
• A service orientation and a “can do” attitude
• A willingness to learn on your own and take initiative
• Displays strength-based approach to collaborative problem solving
• The ability to receive feedback and apply it to work performance
• Consistently demonstrates strong ethics and sound judgement
• Effectively engages diverse populations (age, ethnic groups, socio-economic levels, etc.) and provides culturally sensitive coaching, education and assistance to members and their families
• Experience in conflict management and problem resolution
• A low ego and humility; an ability to gain trust through good communication and doing what you say you will do

Experience to drive change

• Active Registered Nurse with current licensure in state of practice
• 3+ years of recent experience as a nurse in concurrent review, in-hospital/clinical case/care management, or post discharge environments
• Working knowledge of direct, critical patient care and the ability to make discharge planning decisions
• Experience coordinating care across multiple settings and with multiple providers
• Valid Driver's license
• Care management experience in a setting that requires assessment, critical thinking, and application.
• Experience with Medicare, complex populations, and managed care strongly preferred
• Comfort with technology including Microsoft suite of products
• Experience with InterQual or MCG
• Utilizing a variety of electronic health records including data capture, data mining and reporting
• Willingness and flexibility that allows for occasional evening / weekend coverage for patient care coordination and support
• Willingness to travel between local hospitals and work remotely when not in the hospital or office

How you will thrive

In addition to competitive salaries, a 401k program with company match, bonus and a valuable health benefits package, VillageMD offers paid parental leave, pre-tax savings on commuter expenses, and generous paid time off. You work in a highly-collaborative, conscientious, forward-thinking environment that welcomes your experience and enables you to make a significant impact from Day 1.

Most importantly, you make a difference. You see a clear connection between your daily work on VillageMD products and services and the advancement of innovative solutions and improved quality of healthcare for providers and patients.

Our unique VillageMD culture – how inclusion and diversity make the difference

At VillageMD, we see diversity and inclusion as a source of strength in transforming healthcare. We believe building trust and innovation are best achieved through diverse perspectives. To us, acceptance and respect are rooted in an understanding that people do not experience things in the same way, including our healthcare system. Individuals seeking employment at VillageMD are considered without regard to race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status. 

Those seeking employment at VillageMD are considered without regard to race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status or disability status.

Explore your future with VillageMD today.