In this role, the selected candidate must have the ability to speak with and conduct clinical review with medical directors. Ability to work with Prior Auth, and other nursing teams to include Appeals & Grievance. Ability to read and comprehend clinical documentation.
Support the patients in a professional manner consistent with existing or new policies. Case Managers may be called upon to provide recommendations and assist in the development of program goals and objectives for the up-coming year.
Coordinates management of care for a specified patient population in a single hospital; follows patients throughout the continuum of care and ensures optimum utilization of resources, service delivery and compliance with external review agencies.
Position works closely with Primary Care and Specialist physicians, Medical Director, ancillary providers and case management to coordinate member care. Position performs function of a clinical resource to non-licensed staff.