Attends education sessions each year for internal and external customers regarding utilization management. RN with current state licensure. Knowledge of InterQual or related evidenced based criteria sets. Two years of experience in case management, utilization management or related field.
Ability to make personal visits to meet with clients. At least 4 years of direct patient care experience. Bachelor of Science. Education and credentials as an allied health care professional (RN, PharmD, RD, etc) Familiarity with different types of patient adherence tools and approaches.
Candidates will be responsible for the following: Educating members and enhance member understanding of disease impact. Collaborating with Primary Care Physicians and other ancillary healthcare providers. Collecting member medical information from a variety of sources. Qualifications Include:
Educate members regarding their Discharge Instructions. Position Requirements Include: Registered Nurse with licensure in the state(s) of practice. Expertise in Case Management and knowledge of URAC standards. Broad knowledge of health care delivery/managed care regulations.
Maintaining knowledge of Medical Terminology and Medical Diagnostic Categories/Disease States. Educating members in order to enhance member understanding of illness/disease impact. Communicating effectively while performing customer telephonic interviewing. Position Requirements Include:
Position Requirements Include: Training period in the office for 6 weeks required; travel up to 10% 3+ years of clinical experience required. The highest level of education for candidates in this position is a Associate's degree or equivalent experience.