In this role, the selected candidate will
be utilizing Milliman criteria to determine if patients are in the correct hospital setting; making "welcome home" calls to ensure that discharged member receive the necessary services and resources.
Performing accurate OASIS collection, ensuring the medication profile remains current, ensuring lab values have been reported to the physician timely, attending weekly case conference and monthly case manager meetings are key responsibilities of this role.
In this role, you will be responsible for
the tracking and managing of members identified as Intensive Case Management (ICM) who may be high risk, high utilizing, at significant clinical risk or under-utilizing services.