Medical Case Manager
3 days ago
We are seeking a skilled Medical Case Manager to join our team at MedPOINT Management.
As an Outpatient Utilization Specialist, you will play a crucial role in ensuring the quality and efficiency of our healthcare services.
The estimated salary for this position is between $42,000 and $48,000 per year, depending on experience and qualifications.
About the JobThis is a full-time opportunity that requires strong communication and organizational skills, as well as the ability to work effectively with multiple stakeholders.
The successful candidate will have a current California RN or LVN license and at least 2 years of experience in utilization management.
You will be responsible for reviewing and processing precertification requests, working closely with medical directors to determine high-quality medical outcomes, and maintaining accurate documentation and records.
Key Responsibilities- Review and process precertification requests for medical necessity, escalating referrals to medical directors when additional expertise is required
- Use effective relationship management, coordination of services, resource management, education, member advocacy, and related interventions to promote improved quality of care and/or life, prevent hospitalization when possible and appropriate, provide for continuity of care, and ensure appropriate levels of care are received by members
- Maintain knowledge of UM Decision Criteria Hierarchy by health plan and line of business
- Maintain accurate documentation and records of all communications and interventions with members, member representatives, and providers
- Current California RN or LVN license
- At least 2 years of experience in utilization management
- Proficiency with Microsoft Office Programs; primarily Word and Excel
- EZ-CAP knowledge a plus
MedPOINT Management is a leading healthcare organization dedicated to providing high-quality services to our patients and communities.
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