Utilization Management Nurse Consultant
POSITION SUMMARY Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program. Requires an RN with unrestricted active license. It is important to have the ability to recognize quality of care issues and escalate them through established channels. This position requires strong computer skills, which includes the ability to navigate multiple systems. Candidates are expected to have strong written and verbal communication skills. The work is sedentary and includes telephonic outreach, review of electronic correspondence, and computer Read more […]
Case Manager
POSITION SUMMARY The Case Manager utilizes a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individuals benefit plan and/or health needs through communication and available resources to promote optimal, cost-effective outcomes. Requires an RN with unrestricted active license. The CM process includes: assessing the member’s health status and care coordination needs, inpatient review and discharge planning, developing and implementing the CM plan, monitoring and evaluating the plan and involving the Medical Director as indicated and closing Read more […]