Supervisor, Case Management - Health Plans - Tampa, FL
Guarantee compliance with established referral, pre-certification and authorization insurance policies, procedures and processes by associated Medical Providers employees.
Guarantee compliance with established onsite and concurrent evaluate, case management, referral, pre
certification and authorization insurance policies, procedures and processes.
Guarantee compliance with emergency management insurance policies, procedures and processes.
Facilitate on-going communication between case management employees, utilization management employees and contracted suppliers.
Help with the implementation of insurance policies and procedures relating to medical case management.
Keep compliance with federal and state laws and contractual agreements.
Coordinate and talk medical service features with different departmental features.
Act as medical useful resource for appeals perform.
Help Medical Providers employees with pc methods points associated to case management.
Conduct telephonic assessment of instances with docs, hospitals, and different suppliers.
Compile and evaluation a number of reviews for statistical and monetary monitoring functions to determine case management developments and help in monetary forecasting
Qualifications
Schooling/Expertise: three+ years of nursing expertise in an acute care setting notably in a medical/surgical, pediatrics, or obstetrics surroundings. 1+ yr of case and/or utilization management expertise. Working information of a specialised or technical subject comparable to medical nursing, case and/or utilization management. Earlier expertise as a lead in a practical space or managing cross practical groups on giant scale tasks. Knowledge management expertise most popular.
License/Certification: Legitimate driver’s license. Present state’s RN license.
SUBMIT YOUR CV HERE
Komentar
Posting Komentar