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Case Manager
3 months ago
Job Description:
All UM standard/ expedited Inpatient, Outpatient and Custodial Care clinical reviews for MLTC members.
Must Have Skills:
Must have experience in UM, experience with Turnaround Timeframes, good with computer systems and be able to learn a new system, have done clinical reviews and processed denials and partial denial determinations, know MCG and can use it, case presentation for medical reviews, know Medicaid/ Medicare guidelines. Bi-lingual Spanish, Bengali or Mandarin. - PREFERRED
Day to Day Responsibilities:
All UM standard Inpatient, Outpatient and Custodial Care processes and workflows for any requests, verbal notifications for denials/partial denials to both member and provider, participation in IDTs, personal queue management and clinical reviews.
Required Years of Experience:
At least 1-2 years experience in UM.
Required Licensure / Education: Licensure required is a NY State License Practical Nurse or Registered Nurse -LPN NY & NY RN
MedNational professionals experience career opportunities in the following niche areas:
• Hospitals
• Physicians’ offices
• Nursing care facilities
• Home healthcare services
• Government agencies
• Educational services
• Support services
• Schools
• Community centers
• Urgent care centers
• Offices
Today, we conduct business in all corners of North America, and continue to be laser focused on our mission. We deliver our clients with career oriented and quality-focused health care professionals while enriching the lives of these professionals during their period of transition to a new challenge and opportunity.Company DescriptionSince our founding in 2005, MedNational has grown into a full-service Healthcare Human Capital Solutions Organization. We are proud to deliver our traditional permanent placement and contract service opportunities.\r
\r
MedNational professionals experience career opportunities in the following niche areas:\r
• Hospitals\r
• Physicians’ offices\r
• Nursing care facilities\r
• Home healthcare services\r
• Government agencies\r
• Educational services\r
• Support services\r
• Schools\r
• Community centers\r
• Urgent care centers\r
• Offices\r
\r
Today, we conduct business in all corners of North America, and continue to be laser focused on our mission. We deliver our clients with career oriented and quality-focused health care professionals while enriching the lives of these professionals during their period of transition to a new challenge and opportunity.
