The Utilization Management Assistant evaluates certification requests by reviewing group-specific requirements and triaging calls to determine if a nurse is needed. They are responsible for reviewing medical records, coordinating with healthcare providers, and ensuring patients receive appropriate, cost-effective care.
The Utilization Management Assistant handles initial calls for utilization review, evaluates certification requests, and triages calls for nursing staff. They are responsible for reviewing medical records and coordinating with healthcare providers to ensure appropriate and cost-effective patient care.
The RN Case Manager will assess, plan, and coordinate care for consumers to ensure quality outcomes and cost-effective treatment. They will also provide telephonic case management, utilization review, and serve as a liaison between consumers and benefit administrators.
The RN Case Manager will assess, plan, and coordinate care for assigned consumers to ensure quality and cost-effective treatment. They will also serve as a liaison between consumers and benefit administrators while providing telephonic case management and utilization review.
