Washington Licensed Care Coordinator

Job Summary

Working remotely in a full-time capacity, the Washington Licensed Care Coordinator will perform medical necessity reviews, consult with Medical Directors, and document clinical information to ensure compliance with healthcare protocols and improve patient care outcomes.

Key responsibilities

• Conducts medical necessity reviews for inpatient admissions, outpatient services, and prior authorizations to ensure compliance with established criteria
• Collaborates with Medical Directors and various departments to assess and document clinical requests accurately
• Identifies clinical program opportunities and refers members to appropriate healthcare programs as needed

Required qualifications

• Bachelor's degree or four years of relevant work experience
• Current State Licensure as a registered nurse
• Three years of clinical experience
• Utilization Management experience (preferred)
• Experience in the health plan industry (preferred)