Prior Auth/UM Review Nurse
• Concurrent review of patient’s clinical information for efficiency
• Ongoing review of precertification requests for medical necessity
• Monitor the activities of clinical and non-clinical staff
• Coordinates patient’s discharge planning needs with the healthcare team
• Maintain accurate records of all patient related interactions
• Prepare monthly patient management and cost savings report
• Work in an intensive, fast-paced environment with minimal supervision
• Ability to stay organized and interact well with others in any situation
• Provide daily updates to Manager of Utilization Management for review
Nurse Case Manager
• Develops, implement, and evaluate individualized patient care plans.
• Assessing their conditions and needs in order to develop personalized care plans.
• Documenting clients’ case management plans and on-going activities
• Identifying and addressing client risk factors and/or obstacles to care
• Communicating the care preferences of clients, serving as their advocate, and verifying that interventions meet the client’s needs and goals of treatment
• Developing a client-focused case management plan
• Educating the client/family/caregiver about the case management process and evaluating their understanding of the process
