Address
Form of work
Salary- Keep abreast of all current rules, regulations, policies, and procedures related to the utilization program.
- Maintain knowledge of screening criteria used in the utilization review process, quality assurance, employee health and infection control and be able to apply them objectively.
- Record and maintain documentation of all reviews and utilization review data.
- Refer cases which do not meet criteria to the physician advisor to review case.
- Bring unknown or suspected problems of under utilization, over utilization, or inappropriate scheduling of services to the attention of Care Management Director.
- Communicate with external review agencies to develop plans for individual health care needs and conserving benefit utilization.
- Conduct a comprehensive assessment on all patients, identifying potential and actual patient problems/post discharge needs in a timely manner.
- Anticipate post discharge needs through initial and ongoing assessments, make appropriate referrals for post discharge healthcare needs and document interventions.
- Collaborate with physicians, social worker and healthcare team in formulating a safe discharge plan.
