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Company: MedStar Health
Location: Washington, DC
Career Level: Mid-Senior Level
Industries: Not specified

Description

General Summary of Position
Provides support for the Care Management Department by coordinating and promoting comprehensive quality cost-effective care.

Primary Duties and Responsibilities


  • Assists in the identification of potential Case Management candidates through clinical review selected diagnoses etc. and makes appropriate referrals.
  • Contributes to the achievement of established department goals and objectives and adheres to department policies procedures quality standards and safety standards. Complies with governmental and accreditation regulations.
  • Demonstrates behavior consistent with MedStar Health mission vision goals objectives and patient care philosophy.
  • Identifies and reports potential coordination of benefits subrogation third party liability workers compensation cases etc. Identifies quality risk or utilization issues to appropriate MedStar personnel.
  • Initiates contact with providers to obtain clinical information to facilitate care or pending pre-certification requests. Interacts with assigned disease management populations of limited volume. Interaction is designed to improve patient access to care and education regarding the disease and support services.
  • Maintains current knowledge of MedStar Family Choice benefits and enrollment issues in order to accurately coordinate services.
  • Maintains expertise in general benefit management and serves as a resource for MedStar Family Choice members physicians and staff for benefit interpretation and coordination.
  • Maintains timely and accurate documentation in the IS System per Case Management policy.
  • Participates in meetings work groups etc. as assigned.
  • Processes pre-authorizations for medical necessity LOC covered benefits and participation of the provider at the discretion of the guidelines and Medical Reviewer.
  • Sends reviews to Medical Reviewer as appropriate. Coordinates review decisions and notifications per policy.
  • Minimal Qualifications
    Education
    • Valid LPN License in the State of Maryland. required
    Experience
    • 1-2 years Utilization review experience required and
    • 3-4 years Diverse clinical experience required
    Licenses and Certifications
    • LPN - Licensed Practical Nurse - State Licensure Valid LPN license in the State of Maryland or District of Columbia. Upon Hire required
    Knowledge Skills and Abilities
    • Knowledge of current trends in healthcare delivery and utilization review criteria.
    • Ability to use computer to enter and retrieve data.
    • Ability to create edit and analyze (Word Excel and PowerPoint) preferred

    This position has a hiring range of

    USD $60,632.00 - USD $107,494.00 /Yr.


     Apply on company website