Sr. Clinical Review Manager
Apply NowCompany: Integrated Home
Location: Miramar Beach, FL 32550
Description:
Who we are:
IHCS provides an Integrated Delivery System in the home setting, which includes, DME, Respiratory, Home Health and Home Infusion services. IHCS has a select network of Medicare and/or Medicaid Certified and Accredited providers to respond to the needs of our patients - 24/7. We operate with the sole intent of providing the highest quality in-home care services that improve and enhance the daily living for our patients, where our patients are #1
With over 30 years of experience, we are the trusted market leader in Home Health, Durable Medical Equipment, and Home Infusion Services. If you are passionate about inspiring, motivating, and leading teams this opportunity could be for you and we want to hear from you!
Join our team as we strive for excellence through teamwork. We are committed to delivering high quality care to our patients through Exceptional Customer Service, Proven Outcomes, and Seamless Care.
Full time team members competitive compensation package, include but not limited to;
What will you be doing:
The Senior Clinical Review Manager is responsible for overseeing the clinical review and management of utilization management (UM) program related to home health and durable medical equipment (DME) services. This role ensures compliance with regulatory requirements, payer guidelines, and internal policies while driving process improvements to optimize review efficiency and ensure accuracy of medical necessity decisions. The Senior Clinical Review Manager will lead a team of clinicians, collaborate with internal and external stakeholders, and provide strategic oversight to ensure high-quality and timely review of UM determinations.
What will you come with:
Join our team as we strive for excellence through teamwork, where our patients are #1!
IHCS is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.
IHCS provides an Integrated Delivery System in the home setting, which includes, DME, Respiratory, Home Health and Home Infusion services. IHCS has a select network of Medicare and/or Medicaid Certified and Accredited providers to respond to the needs of our patients - 24/7. We operate with the sole intent of providing the highest quality in-home care services that improve and enhance the daily living for our patients, where our patients are #1
With over 30 years of experience, we are the trusted market leader in Home Health, Durable Medical Equipment, and Home Infusion Services. If you are passionate about inspiring, motivating, and leading teams this opportunity could be for you and we want to hear from you!
Join our team as we strive for excellence through teamwork. We are committed to delivering high quality care to our patients through Exceptional Customer Service, Proven Outcomes, and Seamless Care.
Full time team members competitive compensation package, include but not limited to;
- Medical, Vision, Dental, Short- and Long-term insurance
- 6+ Days of Holidays Pay
- 15+ days of PTO
- Employer paid life insurance
- 401K with employer contribution
- Wellness program with reward incentives
- Employee recognition and reward programs
- Offering Hybrid Remote/Telecommute Work Schedule
What will you be doing:
The Senior Clinical Review Manager is responsible for overseeing the clinical review and management of utilization management (UM) program related to home health and durable medical equipment (DME) services. This role ensures compliance with regulatory requirements, payer guidelines, and internal policies while driving process improvements to optimize review efficiency and ensure accuracy of medical necessity decisions. The Senior Clinical Review Manager will lead a team of clinicians, collaborate with internal and external stakeholders, and provide strategic oversight to ensure high-quality and timely review of UM determinations.
What will you come with:
- State licensure as RN
- Bachelor's degree in Nursing (BSN), Healthcare Administration, or a related field (Master's degree preferred).
- Registered Nurse (RN), or equivalent clinical license required.
- Minimum of 3-5 years of experience in utilization management, case management, or a related healthcare setting.
- Prior experience in UM review management, denials, appeals, and payer relations preferred
- At least 2 years of leadership or supervisory experience in a healthcare environment
- Strong understanding of utilization management, medical necessity criteria, and regulatory compliance (e.g., CMS, NCQA, URAC).
- Required to uphold compliance principles as outlined in the Code of Conduct and related policies. Actively supports and participates in mandatory Corporate Compliance Program training initiatives annually or as required.
Join our team as we strive for excellence through teamwork, where our patients are #1!
IHCS is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.