Case Manager

Join our client, a leading healthcare organization, as a Utilization Management Case Manager and play a vital role in ensuring quality patient care through expert utilization review. In this remote position, you will leverage your clinical expertise to evaluate medical requests, make informed decisions, and support efficient healthcare management. This is an excellent opportunity for a dedicated professional to contribute to a dynamic team committed to organizational excellence.

$45.00 - $50.00 per hour

• Analyze and assess medical authorization requests using clinical criteria such as Inter Qual, adhering to company policies and procedures.
• Evaluate treatment plans and determine the medical necessity of services for various lines of business, including Medicaid/Mass Health.
• Facilitate the review process by managing incoming documentation, patient records, and clinical information to support accurate decision‑making.
• Collaborate effectively with physicians and internal teams to coordinate care and review outcomes.
• Maintain productivity and quality standards while managing multiple cases efficiently.
• Communicate clearly and professionally with healthcare providers and internal stakeholders.
• Participate in on‑call duties on a rotational basis to support 24/7 coverage.
• Stay current with industry best practices and organizational protocols to optimize care review processes.
• Utilize a variety of tools and systems including Microsoft Office, SharePoint, McKesson Inter Qual, and web‑based platforms to streamline workflows.

• Registered Nurse (RN) license required.
• 1-2 years of utilization review experience in a managed care setting, with specific expertise in outpatient authorization.
• Demonstrated ability to review 25-30 cases daily using Inter Qual criteria.
• Strong knowledge of Medicaid/Mass Health programs and insurance plans, including commercial and self‑insured.
• Ability to work independently within a hybrid or remote environment.
• Excellent communication and problem‑solving skills.
• High motivation and self‑direction, with an aptitude for multi‑tasking.
• Flexibility to work a weekend schedule (Saturday through Wednesday).

The Hollister Group is an equal opportunity employer. We welcome and encourage applications from people who are under‑represented in their respective occupation or position.