PriMed Management Consulting Services, Inc.

The RN Case Manager provides telephonic and digital case management services to support health plan members during transitions from hospital to home. This role involves assessing patient needs, developing individualized care plans, and coordinating care across various providers to prevent readmissions and improve health outcomes.

The Clinical Data Abstractor II is responsible for reviewing and analyzing clinical data from medical records to ensure compliance with quality measures and regulatory standards. They also support population health initiatives by preparing reports, coordinating with provider offices, and assisting in closing gaps in patient care.

Provide telephonic psychosocial assessments and interventions to assist patients with care transitions and coping with illnesses or life situations. Collaborate with interdisciplinary teams and community agencies to address social determinants of health and improve overall member well-being.

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.

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.