In this role, the selected candidate will assist members in identifying modifiable risk factors and referring and leveraging the coaching resources provided by employer to coach on lifestyle change, including weight management, quitting tobacco, stress reduction, nutrition and increasing physical activity.
In this role, the Transition Case Manager will be responsible for managing the care of high risk patients, community clients or populations that are at risk for poor health outcomes and frequent hospital re-admissions.
This position is responsible for having a thorough understanding of patient treatment plans through participative discussions with the care plan (interdisciplinary) team, identifying and referring requests for services to the Medical Director when guidelines are not met and reviewing inpatient and outpatient services requiring MCO approval.
In this role, you will be assisting in developing strategic plan by partnering with Assistant Director and Fund management to identify opportunities that have direct impact on clinical and financial outcomes.
In this role, you will plan, implements, manages and evaluates the provision of services to ensure that all members needs to met and quality care is provided in accordance with Federal, State and Agency guidelines.
In this role, the selected candidate will assist in developing strategic plan by partnering with Assistant Director and Fund management to identify opportunities (e.g. new programs) that have direct impact on clinical and financial outcomes.
The utilization management nurse will conduct reviews of current inpatient services, and determine medical appropriateness of inpatient and outpatient services following evaluation of medical guidelines and benefit determination in accordance with utilization management policies and procedures.