Episodic Care Manager

Episodic Care Manager responsible for performing clinical reviews to assess medical necessity and coordinate the delivery of health care services for Medicare members. Collaborates with providers, members, and internal staff to ensure high-quality, cost-effective care; conducts clinical evaluations of inpatient/outpatient/DME cases, documents outcomes, and may coordinate peer-to-peer reviews with the Medical Director when guidelines are not met. Requires RN with 3 years or LPN with 5 years of experience and an active clinical license (NC or compact multi-state). Hybrid Flex or Remote Flex work arrangements available, with in-person presence at the Durham, NC HQ as applicable. The role emphasizes interdisciplinary collaboration, regulatory compliance, and detailed clinical documentation.