The Incumbent is responsible for a high level assessment and reassessment process for the patient/family to set priorities, plan, organize, and implement care that is goal-directed toward self-care outcomes.
In this role, you will be responsible to coordinates interdisciplinary referrals utilizing pre-established criteria for quality and appropriateness to the acute care or ambulatory setting. Performs the appropriate utilization review functions on the managed population utilizing approved intensity of service and severity of illness criteria. Supports the performance improvement process through comprehensive analysis of patterns and trends.
The Case Manager- Utilization Management provides timely and appropriate processing of managed care referrals to meet specific healthcare needs in a cost effective manner utilizing available resources.
In this role, you will perform research and analyzes complex issues, assesses member needs. Acquires appropriate clinical records, clinical guidelines, policies, EOC and Benefit Policy. Accurately applies coding guidelines.
In this role, you will coordinate with the health care team and the patient/family to address payer issues that impact care, and to develop a transition plan of care that includes a safe discharge plan and plan for follow up with care providers post discharge.
In this role, you will be responsible for assessing and analyzing an injured employee to evaluate the medical and vocational needs required to facilitate the patients appropriate and timely return to work.
As a Peritoneal Dialysis Registered Nurse (PD RN), you educate your patients on how to do their own dialysis from their homes, and you take responsibility for the complete ongoing care of each patient to ensure their treatment stays on track.
In this role, you will be responsible for working with members and providers to assess, facilitate, plan and coordinate the delivery of care across the continuum for members with potential risk for high cost and high utilization.
in this role, you will manage individual member cases by coordinating the provisions of services, assuring the cost-effective utilization of health care resources to meet individual members health care needs and promote positive health outcomes.