How you will make an impact:
- Gathers clinical information regarding case and determines appropriate area to refer or assign case (utilization management, case management, QI, Med Review).
- Conducts initial review of files to determine appropriate action required. Maintains and updates tracking databases.
- Prepares reports and documents all actions.
- Responds to requests, calls or correspondence within scope.
- Provides general program information to members and providers as requested.
- May review and assist with cases and act as liaison between medical management operations and other internal departments to support ease of administration of medical benefits.
- May assist with the case referral process and collaborate with external community-based organizations to facilitate and coordinate care under the direction of an RN Case Manager.