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Description: Position Purpose\: Perform care management duties to assess, plan and coordinate all aspects of medical and supporting services across the continuum of care for select members to promote quality, cost effective care. Assess the member's...
Description: Position Purpose\: Perform onsite review of emergent/urgent and continued stay requests for appropriate care and setting, following guidelines and policies, and approve services or forward requests to the appropriate Physician or Medical...
Description: Position Purpose\: Assist in day to day operations of non-clinical functions for the Star + Plus Program. Act as primary liaison for staff and conduct screening and risk assessment interventions per program guidelines.Serve as primary point...
Description: Position Purpose\: Determine needs and eligibility of members for various services through field-based collaboration with medical, behavioral, and social support staff. Conduct screening and risk assessment interventions per program...
Description: Position Purpose\: Perform duties related to the day-to-day operations of the High Risk Case Management functions to include working with members identified as high risk to identify needs and goals to achieve empowerment and improved quality...
Description: Position Purpose\: Promote the quality and cost effectiveness of medical care by applying clinical acumen and the appropriate application of policies and guidelines to prior authorization requests. Perform telephonic review of prior...