Active PA Licensed RN or LPN required.
Job Summary
We are seeking a detail-oriented and knowledgeable Care Management Coordinator to join our Utilization Management Clinical Precertification Team . In this role, you will assess members' clinical conditions by reviewing medical records and applying medical necessity criteria to ensure appropriate patient care. Your expertise will enable you to independently authorize medically necessary services and advocate for patients navigating the healthcare system. Additionally, you will collaborate with providers to obtain clinical information and escalate complex cases to the Medical Director when necessary. This position also requires ensuring regulatory compliance with federal, state, and accreditation standards.
Key Responsibilities
Qualifications
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Skills & Competencies:
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