PriMed Management Consulting Services, Inc.

The Authorization Nurse evaluates the medical appropriateness and necessity of services using clinical guidelines and contracts. They collaborate with physician reviewers and providers to ensure members receive timely and efficient medical care.

Provide virtual case management services to health plan members to ensure smooth transitions after hospitalizations and prevent readmissions. Coordinate care across primary, specialty, and behavioral health providers while managing individualized care plans and addressing social determinants of health.

Lead a team of analysts to oversee the accurate support of enrollment and benefits data using the Epic Tapestry application. Act as the primary point of contact for users while ensuring compliance with industry standards and implementing system enhancements.

Support the development of programs and policies to optimize medication and manage chronic disease states. Collaborate with physicians and quality teams to improve patient outcomes and ensure compliance with CMS Star quality measures.